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Sundeep Khosla - One of the best experts on this subject based on the ideXlab platform.
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diminished bone strength is observed in adult women and men who sustained a mild trauma distal Forearm Fracture during childhood
Journal of Bone and Mineral Research, 2014Co-Authors: Joshua N Farr, Joseph L Melton, Sara J Achenbach, Elizabeth J Atkinson, Salman Kirmani, Sundeep Khosla, Louise K Mccready, Shreyasee AminAbstract:Children and adolescents who sustain a distal Forearm Fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age < 18 years) DFF and 150 sex-matched controls with no history of Fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro-finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonFracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health.
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a distal Forearm Fracture in childhood is associated with an increased risk for future fragility Fractures in adult men but not women
Journal of Bone and Mineral Research, 2013Co-Authors: Shreyasee Amin, Joseph L Melton, Sara J Achenbach, Elizabeth J Atkinson, Mark B Dekutoski, Salman Kirmani, Philip R Fischer, Sundeep KhoslaAbstract:Distal Forearm Fractures are among the most common Fractures during childhood, but it remains unclear whether they predict an increased Fracture risk later in life. We studied a population-based cohort of 1776 children ≤18 years of age, from Olmsted County, MN, USA, who had a distal Forearm Fracture in 1935–1992. Incident Fractures occurring at age ≥35 years were identified through review of complete medical records using the linkage system of the Rochester Epidemiology Project. Observed nonpathologic Fractures resulting from no more than moderate trauma (fragility Fractures) were compared with expected numbers estimated from Fracture site–specific incidence rates, based on age, sex, and calendar year, for Olmsted County (standardized incidence ratios [SIR]). In 1086 boys (mean ± SD age; 11 ± 4 years) and 690 girls (10 ± 4 years) followed for 27,292 person-years after the age of 35 years, subsequent fragility Fractures were observed in 144 (13%) men and 74 (11%) women. There was an increased risk for future fragility Fractures in boys who had a distal Forearm Fracture (SIR, 1.9; 95% CI, 1.6–2.3) but not girls (SIR, 1.0; 95% CI, 0.8–1.2). Fragility Fractures at both major osteoporotic (hip, spine, wrist, and shoulder) sites (SIR, 2.6; 95% CI, 2.1–3.3) and remaining sites (SIR, 1.7; 95% CI, 1.3–2.0) were increased in men, irrespective of age at distal Forearm Fracture as boys. A distal Forearm Fracture in boys, but not girls, is associated with an increased risk for fragility Fractures as older adults. It is necessary to determine whether the increased Fractures observed in men is due to persistent deficits of bone strength, continued high Fracture risk activity, or both. Until then, men should be asked about a childhood distal Forearm Fracture and, if so, warrant further screening and counseling on measures to optimize bone health and prevent Fractures.
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assessing Forearm Fracture risk in postmenopausal women
Osteoporosis International, 2010Co-Authors: L. J. Melton, Shreyasee Amin, Sara J Achenbach, Elizabeth J Atkinson, Ralph Muller, David Christen, B L Riggs, G H Van Lenthe, Sundeep KhoslaAbstract:Summary A diverse array of bone density, structure, and strength parameters were significantly associated with distal Forearm Fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.
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contribution of in vivo structural measurements and load strength ratios to the determination of Forearm Fracture risk in postmenopausal women
Journal of Bone and Mineral Research, 2007Co-Authors: Joseph L Melton, Shreyasee Amin, Sara J Achenbach, Elizabeth J Atkinson, Lawrence B Riggs, Harry G Van Lenthe, Ralph Muller, Mary L Bouxsein, Sundeep KhoslaAbstract:Bone structure, strength, and load-strength ratios contribute to Forearm Fracture risk independently of areal BMD. Introduction: Technological and conceptual advances provide new opportunities for evaluating the contributions of bone density, structure, and strength to the pathogenesis of distal Forearm Fractures. Materials and Methods: From an age-stratified random sample of Rochester, MN, women, we compared 18 with a distal Forearm Fracture (cases) to 18 age-matched women with no osteoporotic Fracture (controls). High-resolution pQCT was used to assess volumetric BMD (vBMD), geometry, and microstructure at the ultradistal radius, the site of Colles' Fractures. Failure loads in the radius were estimated from microfinite element (μFE) models derived from pQCT. Differences between case and control women were assessed, and the risk of Fracture associated with each variable was estimated by logistic regression analysis. Results: Given similar heights, estimated loading in a fall on the outstretched arm was the same in cases and controls. However, women with Forearm Fractures had inferior vBMD, geometry, microstructure, and estimated bone strength. Relative risks for the strongest determinant of Fracture in each of the five main variable categories were as follows: BMD (total vBMD: OR per SD change, 4.2; 95% CI, 1.4–12), geometry (cortical thickness: OR, 4.0; 95% CI, 1.4–11), microstructure (trabecular number: OR, 2.3; 95% CI, 1.02–5.1), and strength (axial rigidity: OR, 3.8; 95% CI, 1.4–10); the factor-of-risk (fall load/μFE failure load) was 24% greater (worse) in cases (OR, 3.0; 95% CI, 1.2–7.5). Areas under ROC curves ranged from 0.72 to 0.82 for these parameters. Conclusions: Bone geometry, microstructure, and strength contribute to Forearm Fractures, as does BMD, and these additional determinants of risk promise greater insights into Fracture pathogenesis.
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Secondary osteoporosis and the risk of distal Forearm Fractures in men and women
Bone, 2002Co-Authors: Lee J. Melton, Sara J Achenbach, William M. O'fallon, Sundeep KhoslaAbstract:Abstract Secondary osteoporosis plays an important role in the pathogenesis of hip and spine Fractures, but relatively little is known about the potential impact of secondary osteoporosis and fall-related disorders on the risk of distal Forearm Fractures. To address this issue, we conducted a population-based, nested case-control study comparing 496 Rochester, Minnesota, residents with an initial distal Forearm Fracture to an equal number of age- and gender-matched controls. Potential risk factors were assessed by review of each subject’s complete (inpatient and outpatient) medical records in the community (median duration >30 years) and analyzed using multiple logistic regression. Although history of diabetes mellitus in women (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15–0.75) and long-term anticonvulsant use in both genders (OR 3.58, 95% CI 1.26–10) were independently associated with Fracture risk in a multivariate analysis, the conditions linked with secondary osteoporosis had, in aggregate, no statistically significant association with distal Forearm Fractures. Fall-related conditions altogether were associated with a borderline increase in risk (OR 1.36, 95% CI 0.98–1.91) and might have accounted for 19% of Forearm Fracture occurrence in the community. Among women (OR 2.72, 95% CI 1.20–6.19), but not men, a history of prior osteoporotic Fracture was also associated with an increase in distal Forearm Fractures. These factors do not appear to account for the discrepancy in Forearm Fracture incidence in women when compared with men.
Jan A N Verhaar - One of the best experts on this subject based on the ideXlab platform.
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which factors affect limitation of pronation supination after Forearm Fractures in children a prospective multicentre study
Injury-international Journal of The Care of The Injured, 2014Co-Authors: Joost W Colaris, Jan Hein Allema, Max Reijman, Mark R De Vries, Ulas L Biter, Rolf M Bloem, Cees P Van De Ven, Jan A N VerhaarAbstract:Abstract Introduction Both-bone Forearm Fractures in children frequently result in a limitation of pronation/supination, which hinders daily activities. The purpose of this prospective multicentre study was to investigate which clinical factors are related to the limitation of pronation/supination in children with a both-bone Forearm Fracture. Methods In four Dutch hospitals, consecutive children ( Results A group of 410 children with both-bone Forearm Fractures were included, of which 10 children missed the final examination (follow-up rate of 97.6%). We found that a re-Fracture (odds ratio (OR) 11.7, 95% confidence interval (CI) 1.2; 118.5), a Fracture in the diaphysis (OR 3.3, 95% CI 1.4; 7.9) and less physiotherapy during follow-up (OR 0.90, 95% CI 0.82; 0.98) were independently associated with a limitation of pronation/supination of 20° or more. Conclusions These findings imply that a re-Fracture and a diaphyseal located Fracture were associated independently of each other with a limitation of pronation/supination in children with a both-bone Forearm Fracture. Furthermore, in children with severe limitation extensive physiotherapy is associated with better functional outcome.
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Three-dimensional imaging of children with severe limitation of pronation/supination after a both-bone Forearm Fracture
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Joost W Colaris, Jan Hein Allema, Max Reijman, Stanley Oei, Herma Holscher, Jan A N VerhaarAbstract:Introduction Although both-bone Forearm Fractures in children may result in severe limitation of Forearm rotation, finding the cause remains a diagnostic challenge. This study tries to evaluate the role of rotational malunion, bony impingement and contractures of the interosseous membrane. Patients and methods Children (5–16 years) who suffered from a both-bone Forearm Fracture in diaphysis or distal metaphysis with a limitation of pronation/supination ≥40° at ≥6 months after trauma were included for analysis with conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Results A total of 410 children with a both-bone Forearm Fracture were prospectively followed in four Dutch hospitals. At a median of 205 days, 7.3 % suffered from a limitation of pronation/supination ≥40°. 14 children were included (median limitation of 40°) and the radiographs revealed a median maximum angular malunion of 16°. CT analysis showed rotational malunion of both radius (median 19°) and ulna (median 9°). MRI analysis revealed neither bony impingement nor contractures of the interosseous membrane. Conclusions Three-dimensional imaging of children with a severe limitation of pronation/supination after a both-bone Forearm Fracture revealed rotational malunions of both radius and ulna without bony impingement or soft tissue contractures. Level of evidence Prospective multicenter study, Level 2.
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three dimensional imaging of children with severe limitation of pronation supination after a both bone Forearm Fracture
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Joost W Colaris, Jan Hein Allema, Max Reijman, Stanley Oei, H C Holscher, Jan A N VerhaarAbstract:Although both-bone Forearm Fractures in children may result in severe limitation of Forearm rotation, finding the cause remains a diagnostic challenge. This study tries to evaluate the role of rotational malunion, bony impingement and contractures of the interosseous membrane. Children (5–16 years) who suffered from a both-bone Forearm Fracture in diaphysis or distal metaphysis with a limitation of pronation/supination ≥40° at ≥6 months after trauma were included for analysis with conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). A total of 410 children with a both-bone Forearm Fracture were prospectively followed in four Dutch hospitals. At a median of 205 days, 7.3 % suffered from a limitation of pronation/supination ≥40°. 14 children were included (median limitation of 40°) and the radiographs revealed a median maximum angular malunion of 16°. CT analysis showed rotational malunion of both radius (median 19°) and ulna (median 9°). MRI analysis revealed neither bony impingement nor contractures of the interosseous membrane. Three-dimensional imaging of children with a severe limitation of pronation/supination after a both-bone Forearm Fracture revealed rotational malunions of both radius and ulna without bony impingement or soft tissue contractures. Prospective multicenter study, Level 2.
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pronation and supination after Forearm Fractures in children reliability of visual estimation and conventional goniometry measurement
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Joost W Colaris, Jan Hein Allema, Marleen Van Der Linden, Ruud W Selles, Napoleon Coene, Jan A N VerhaarAbstract:Abstract Background Forearm Fractures are common amongst children and often result in limited rotational function. In daily practice, pronation and supination of the arm are often visually estimated or measured using a conventional goniometer. The aim of this study was to compare the reliability of these two methods in paediatric patients who had previously sustained a Forearm Fracture. Methods Intra- and interrater reliability of visual estimation and conventional goniometry were determined in 47 children who had previously sustained a Forearm Fracture. Results Intra- and interrater reliability of visual estimation and conventional goniometry was fair to excellent, with intraclass correlation coefficients (ICCs) ranging between 0.75 and 0.94. In addition, the overall goniometer data consistently showed lower smallest detectable differences (SDDs) compared to the visual estimation data, also indicating better reliability for the goniometer method. Conclusions A conventional goniometer is an easy, fast and reliable method to determine the pronation and supination in a child who had sustained a Forearm Fracture. If an uncooperative child hinders the measurement, visual estimation is a good second choice. Measurements are more reliable when repeated by the same professional.
Shreyasee Amin - One of the best experts on this subject based on the ideXlab platform.
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diminished bone strength is observed in adult women and men who sustained a mild trauma distal Forearm Fracture during childhood
Journal of Bone and Mineral Research, 2014Co-Authors: Joshua N Farr, Joseph L Melton, Sara J Achenbach, Elizabeth J Atkinson, Salman Kirmani, Sundeep Khosla, Louise K Mccready, Shreyasee AminAbstract:Children and adolescents who sustain a distal Forearm Fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age < 18 years) DFF and 150 sex-matched controls with no history of Fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro-finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonFracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health.
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a distal Forearm Fracture in childhood is associated with an increased risk for future fragility Fractures in adult men but not women
Journal of Bone and Mineral Research, 2013Co-Authors: Shreyasee Amin, Joseph L Melton, Sara J Achenbach, Elizabeth J Atkinson, Mark B Dekutoski, Salman Kirmani, Philip R Fischer, Sundeep KhoslaAbstract:Distal Forearm Fractures are among the most common Fractures during childhood, but it remains unclear whether they predict an increased Fracture risk later in life. We studied a population-based cohort of 1776 children ≤18 years of age, from Olmsted County, MN, USA, who had a distal Forearm Fracture in 1935–1992. Incident Fractures occurring at age ≥35 years were identified through review of complete medical records using the linkage system of the Rochester Epidemiology Project. Observed nonpathologic Fractures resulting from no more than moderate trauma (fragility Fractures) were compared with expected numbers estimated from Fracture site–specific incidence rates, based on age, sex, and calendar year, for Olmsted County (standardized incidence ratios [SIR]). In 1086 boys (mean ± SD age; 11 ± 4 years) and 690 girls (10 ± 4 years) followed for 27,292 person-years after the age of 35 years, subsequent fragility Fractures were observed in 144 (13%) men and 74 (11%) women. There was an increased risk for future fragility Fractures in boys who had a distal Forearm Fracture (SIR, 1.9; 95% CI, 1.6–2.3) but not girls (SIR, 1.0; 95% CI, 0.8–1.2). Fragility Fractures at both major osteoporotic (hip, spine, wrist, and shoulder) sites (SIR, 2.6; 95% CI, 2.1–3.3) and remaining sites (SIR, 1.7; 95% CI, 1.3–2.0) were increased in men, irrespective of age at distal Forearm Fracture as boys. A distal Forearm Fracture in boys, but not girls, is associated with an increased risk for fragility Fractures as older adults. It is necessary to determine whether the increased Fractures observed in men is due to persistent deficits of bone strength, continued high Fracture risk activity, or both. Until then, men should be asked about a childhood distal Forearm Fracture and, if so, warrant further screening and counseling on measures to optimize bone health and prevent Fractures.
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assessing Forearm Fracture risk in postmenopausal women
Osteoporosis International, 2010Co-Authors: L. J. Melton, Shreyasee Amin, Sara J Achenbach, Elizabeth J Atkinson, Ralph Muller, David Christen, B L Riggs, G H Van Lenthe, Sundeep KhoslaAbstract:Summary A diverse array of bone density, structure, and strength parameters were significantly associated with distal Forearm Fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.
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contribution of in vivo structural measurements and load strength ratios to the determination of Forearm Fracture risk in postmenopausal women
Journal of Bone and Mineral Research, 2007Co-Authors: Joseph L Melton, Shreyasee Amin, Sara J Achenbach, Elizabeth J Atkinson, Lawrence B Riggs, Harry G Van Lenthe, Ralph Muller, Mary L Bouxsein, Sundeep KhoslaAbstract:Bone structure, strength, and load-strength ratios contribute to Forearm Fracture risk independently of areal BMD. Introduction: Technological and conceptual advances provide new opportunities for evaluating the contributions of bone density, structure, and strength to the pathogenesis of distal Forearm Fractures. Materials and Methods: From an age-stratified random sample of Rochester, MN, women, we compared 18 with a distal Forearm Fracture (cases) to 18 age-matched women with no osteoporotic Fracture (controls). High-resolution pQCT was used to assess volumetric BMD (vBMD), geometry, and microstructure at the ultradistal radius, the site of Colles' Fractures. Failure loads in the radius were estimated from microfinite element (μFE) models derived from pQCT. Differences between case and control women were assessed, and the risk of Fracture associated with each variable was estimated by logistic regression analysis. Results: Given similar heights, estimated loading in a fall on the outstretched arm was the same in cases and controls. However, women with Forearm Fractures had inferior vBMD, geometry, microstructure, and estimated bone strength. Relative risks for the strongest determinant of Fracture in each of the five main variable categories were as follows: BMD (total vBMD: OR per SD change, 4.2; 95% CI, 1.4–12), geometry (cortical thickness: OR, 4.0; 95% CI, 1.4–11), microstructure (trabecular number: OR, 2.3; 95% CI, 1.02–5.1), and strength (axial rigidity: OR, 3.8; 95% CI, 1.4–10); the factor-of-risk (fall load/μFE failure load) was 24% greater (worse) in cases (OR, 3.0; 95% CI, 1.2–7.5). Areas under ROC curves ranged from 0.72 to 0.82 for these parameters. Conclusions: Bone geometry, microstructure, and strength contribute to Forearm Fractures, as does BMD, and these additional determinants of risk promise greater insights into Fracture pathogenesis.
Elizabeth J Atkinson - One of the best experts on this subject based on the ideXlab platform.
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diminished bone strength is observed in adult women and men who sustained a mild trauma distal Forearm Fracture during childhood
Journal of Bone and Mineral Research, 2014Co-Authors: Joshua N Farr, Joseph L Melton, Sara J Achenbach, Elizabeth J Atkinson, Salman Kirmani, Sundeep Khosla, Louise K Mccready, Shreyasee AminAbstract:Children and adolescents who sustain a distal Forearm Fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age < 18 years) DFF and 150 sex-matched controls with no history of Fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro-finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonFracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health.
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a distal Forearm Fracture in childhood is associated with an increased risk for future fragility Fractures in adult men but not women
Journal of Bone and Mineral Research, 2013Co-Authors: Shreyasee Amin, Joseph L Melton, Sara J Achenbach, Elizabeth J Atkinson, Mark B Dekutoski, Salman Kirmani, Philip R Fischer, Sundeep KhoslaAbstract:Distal Forearm Fractures are among the most common Fractures during childhood, but it remains unclear whether they predict an increased Fracture risk later in life. We studied a population-based cohort of 1776 children ≤18 years of age, from Olmsted County, MN, USA, who had a distal Forearm Fracture in 1935–1992. Incident Fractures occurring at age ≥35 years were identified through review of complete medical records using the linkage system of the Rochester Epidemiology Project. Observed nonpathologic Fractures resulting from no more than moderate trauma (fragility Fractures) were compared with expected numbers estimated from Fracture site–specific incidence rates, based on age, sex, and calendar year, for Olmsted County (standardized incidence ratios [SIR]). In 1086 boys (mean ± SD age; 11 ± 4 years) and 690 girls (10 ± 4 years) followed for 27,292 person-years after the age of 35 years, subsequent fragility Fractures were observed in 144 (13%) men and 74 (11%) women. There was an increased risk for future fragility Fractures in boys who had a distal Forearm Fracture (SIR, 1.9; 95% CI, 1.6–2.3) but not girls (SIR, 1.0; 95% CI, 0.8–1.2). Fragility Fractures at both major osteoporotic (hip, spine, wrist, and shoulder) sites (SIR, 2.6; 95% CI, 2.1–3.3) and remaining sites (SIR, 1.7; 95% CI, 1.3–2.0) were increased in men, irrespective of age at distal Forearm Fracture as boys. A distal Forearm Fracture in boys, but not girls, is associated with an increased risk for fragility Fractures as older adults. It is necessary to determine whether the increased Fractures observed in men is due to persistent deficits of bone strength, continued high Fracture risk activity, or both. Until then, men should be asked about a childhood distal Forearm Fracture and, if so, warrant further screening and counseling on measures to optimize bone health and prevent Fractures.
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assessing Forearm Fracture risk in postmenopausal women
Osteoporosis International, 2010Co-Authors: L. J. Melton, Shreyasee Amin, Sara J Achenbach, Elizabeth J Atkinson, Ralph Muller, David Christen, B L Riggs, G H Van Lenthe, Sundeep KhoslaAbstract:Summary A diverse array of bone density, structure, and strength parameters were significantly associated with distal Forearm Fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.
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contribution of in vivo structural measurements and load strength ratios to the determination of Forearm Fracture risk in postmenopausal women
Journal of Bone and Mineral Research, 2007Co-Authors: Joseph L Melton, Shreyasee Amin, Sara J Achenbach, Elizabeth J Atkinson, Lawrence B Riggs, Harry G Van Lenthe, Ralph Muller, Mary L Bouxsein, Sundeep KhoslaAbstract:Bone structure, strength, and load-strength ratios contribute to Forearm Fracture risk independently of areal BMD. Introduction: Technological and conceptual advances provide new opportunities for evaluating the contributions of bone density, structure, and strength to the pathogenesis of distal Forearm Fractures. Materials and Methods: From an age-stratified random sample of Rochester, MN, women, we compared 18 with a distal Forearm Fracture (cases) to 18 age-matched women with no osteoporotic Fracture (controls). High-resolution pQCT was used to assess volumetric BMD (vBMD), geometry, and microstructure at the ultradistal radius, the site of Colles' Fractures. Failure loads in the radius were estimated from microfinite element (μFE) models derived from pQCT. Differences between case and control women were assessed, and the risk of Fracture associated with each variable was estimated by logistic regression analysis. Results: Given similar heights, estimated loading in a fall on the outstretched arm was the same in cases and controls. However, women with Forearm Fractures had inferior vBMD, geometry, microstructure, and estimated bone strength. Relative risks for the strongest determinant of Fracture in each of the five main variable categories were as follows: BMD (total vBMD: OR per SD change, 4.2; 95% CI, 1.4–12), geometry (cortical thickness: OR, 4.0; 95% CI, 1.4–11), microstructure (trabecular number: OR, 2.3; 95% CI, 1.02–5.1), and strength (axial rigidity: OR, 3.8; 95% CI, 1.4–10); the factor-of-risk (fall load/μFE failure load) was 24% greater (worse) in cases (OR, 3.0; 95% CI, 1.2–7.5). Areas under ROC curves ranged from 0.72 to 0.82 for these parameters. Conclusions: Bone geometry, microstructure, and strength contribute to Forearm Fractures, as does BMD, and these additional determinants of risk promise greater insights into Fracture pathogenesis.
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osteoporosis intervention following distal Forearm Fractures a missed opportunity
JAMA Internal Medicine, 2002Co-Authors: Maria Teresa Cuddihy, Elizabeth J Atkinson, Sherine E Gabriel, Cynthia S. Crowson, Claudia C Tabini, Michael W Ofallon, Joseph L MeltonAbstract:Background Fractures are a manifestation of osteoporosis, but therapeutic interventions to reduce the risk of recurrent Fractures are not widespread. Objective To identify predictors of osteoporosis treatment in postmenopausal women following distal Forearm Fracture. Methods This population-based retrospective cohort study included all postmenopausal women, 45 years or older, residing in Olmsted County, Minnesota, who sustained a distal Forearm Fracture due to minimal trauma (a fall from standing height or under) in 1993 to 1997. Complete medical records were reviewed for each subject and Cox proportional hazards regression was used to evaluate the relationship of baseline demographic and clinical characteristics to therapeutic interventions for osteoporosis within 12 months following the Fracture. Results A total of 343 women with a mean age of 70.5 years had a minimal trauma distal Forearm Fracture. Within 12 months, 83% had seen a nonorthopedic physician. Of these, 17% had a pharmacologic osteoporosis intervention and the 12-month actuarially estimated cumulative incidence of any intervention was 18% (95% confidence interval [CI], 14%-22%). In a multivariate analysis, treatment was more likely to be offered to those with a prior diagnosis of osteoporosis (relative risk [RR], 2.08; 95% CI, 1.21-3.58), previous distal Forearm Fracture (RR, 2.38; 95% CI, 1.30-4.34), or history of cigarette smoking (RR, 1.86; 95% CI, 1.11-3.12). Conclusions Effective osteoporosis interventions are underutilized among postmenopausal women who experience an osteoporotic Fracture. Further work is needed to overcome barriers to optimal osteoporosis management in these women who are at high risk for future complications of osteoporosis.
Joost W Colaris - One of the best experts on this subject based on the ideXlab platform.
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which factors affect limitation of pronation supination after Forearm Fractures in children a prospective multicentre study
Injury-international Journal of The Care of The Injured, 2014Co-Authors: Joost W Colaris, Jan Hein Allema, Max Reijman, Mark R De Vries, Ulas L Biter, Rolf M Bloem, Cees P Van De Ven, Jan A N VerhaarAbstract:Abstract Introduction Both-bone Forearm Fractures in children frequently result in a limitation of pronation/supination, which hinders daily activities. The purpose of this prospective multicentre study was to investigate which clinical factors are related to the limitation of pronation/supination in children with a both-bone Forearm Fracture. Methods In four Dutch hospitals, consecutive children ( Results A group of 410 children with both-bone Forearm Fractures were included, of which 10 children missed the final examination (follow-up rate of 97.6%). We found that a re-Fracture (odds ratio (OR) 11.7, 95% confidence interval (CI) 1.2; 118.5), a Fracture in the diaphysis (OR 3.3, 95% CI 1.4; 7.9) and less physiotherapy during follow-up (OR 0.90, 95% CI 0.82; 0.98) were independently associated with a limitation of pronation/supination of 20° or more. Conclusions These findings imply that a re-Fracture and a diaphyseal located Fracture were associated independently of each other with a limitation of pronation/supination in children with a both-bone Forearm Fracture. Furthermore, in children with severe limitation extensive physiotherapy is associated with better functional outcome.
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Three-dimensional imaging of children with severe limitation of pronation/supination after a both-bone Forearm Fracture
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Joost W Colaris, Jan Hein Allema, Max Reijman, Stanley Oei, Herma Holscher, Jan A N VerhaarAbstract:Introduction Although both-bone Forearm Fractures in children may result in severe limitation of Forearm rotation, finding the cause remains a diagnostic challenge. This study tries to evaluate the role of rotational malunion, bony impingement and contractures of the interosseous membrane. Patients and methods Children (5–16 years) who suffered from a both-bone Forearm Fracture in diaphysis or distal metaphysis with a limitation of pronation/supination ≥40° at ≥6 months after trauma were included for analysis with conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Results A total of 410 children with a both-bone Forearm Fracture were prospectively followed in four Dutch hospitals. At a median of 205 days, 7.3 % suffered from a limitation of pronation/supination ≥40°. 14 children were included (median limitation of 40°) and the radiographs revealed a median maximum angular malunion of 16°. CT analysis showed rotational malunion of both radius (median 19°) and ulna (median 9°). MRI analysis revealed neither bony impingement nor contractures of the interosseous membrane. Conclusions Three-dimensional imaging of children with a severe limitation of pronation/supination after a both-bone Forearm Fracture revealed rotational malunions of both radius and ulna without bony impingement or soft tissue contractures. Level of evidence Prospective multicenter study, Level 2.
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three dimensional imaging of children with severe limitation of pronation supination after a both bone Forearm Fracture
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Joost W Colaris, Jan Hein Allema, Max Reijman, Stanley Oei, H C Holscher, Jan A N VerhaarAbstract:Although both-bone Forearm Fractures in children may result in severe limitation of Forearm rotation, finding the cause remains a diagnostic challenge. This study tries to evaluate the role of rotational malunion, bony impingement and contractures of the interosseous membrane. Children (5–16 years) who suffered from a both-bone Forearm Fracture in diaphysis or distal metaphysis with a limitation of pronation/supination ≥40° at ≥6 months after trauma were included for analysis with conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). A total of 410 children with a both-bone Forearm Fracture were prospectively followed in four Dutch hospitals. At a median of 205 days, 7.3 % suffered from a limitation of pronation/supination ≥40°. 14 children were included (median limitation of 40°) and the radiographs revealed a median maximum angular malunion of 16°. CT analysis showed rotational malunion of both radius (median 19°) and ulna (median 9°). MRI analysis revealed neither bony impingement nor contractures of the interosseous membrane. Three-dimensional imaging of children with a severe limitation of pronation/supination after a both-bone Forearm Fracture revealed rotational malunions of both radius and ulna without bony impingement or soft tissue contractures. Prospective multicenter study, Level 2.
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pronation and supination after Forearm Fractures in children reliability of visual estimation and conventional goniometry measurement
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Joost W Colaris, Jan Hein Allema, Marleen Van Der Linden, Ruud W Selles, Napoleon Coene, Jan A N VerhaarAbstract:Abstract Background Forearm Fractures are common amongst children and often result in limited rotational function. In daily practice, pronation and supination of the arm are often visually estimated or measured using a conventional goniometer. The aim of this study was to compare the reliability of these two methods in paediatric patients who had previously sustained a Forearm Fracture. Methods Intra- and interrater reliability of visual estimation and conventional goniometry were determined in 47 children who had previously sustained a Forearm Fracture. Results Intra- and interrater reliability of visual estimation and conventional goniometry was fair to excellent, with intraclass correlation coefficients (ICCs) ranging between 0.75 and 0.94. In addition, the overall goniometer data consistently showed lower smallest detectable differences (SDDs) compared to the visual estimation data, also indicating better reliability for the goniometer method. Conclusions A conventional goniometer is an easy, fast and reliable method to determine the pronation and supination in a child who had sustained a Forearm Fracture. If an uncooperative child hinders the measurement, visual estimation is a good second choice. Measurements are more reliable when repeated by the same professional.