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People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as nontraumatic or those occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61 to 5.22) per 1000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the 5- and 10-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722 to 0.814) and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and could potentially replace the current tools recommended for fracture risk assessment in this population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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http://dx.doi.org/10.1002/jbmr.4894 | DOI Listing |
Jt Dis Relat Surg
January 2025
Department of Orthopedics, Harvard Medical School, The Center For Advanced Orthopedic Studies, BIDMC, Boston, MA, 02215 USA.
Pregnancy and lactation significantly alter bone homeostasis, potentially leading to impaired bone quality and mineralization due to the increased metabolic demands of the developing offspring. While most women with osteopenia during these periods experience a return to baseline bone density after weaning, some may remain at risk for fractures, particularly in cancellous bone. There are inconsistencies in current reports on fracture risk and appropriate treatment strategies.
View Article and Find Full Text PDFJt Dis Relat Surg
January 2025
Gazi Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 06560 Yenimahalle, Ankara, Türkiye.
Objectives: This study aimed to evaluate the impact of integrating obstetric parameters into the Fracture Risk Assessment Tool (FRAX) on the precision of risk assessment.
Patients And Methods: In this retrospective study, patients who experienced postmenopausal fragility fractures of the distal radius, proximal femur, or lumbar vertebrae between January 1, 2021, and December 31, 2023, were included. Obstetric histories, along with standard FRAX parameters, were obtained by phone interviews.
Cureus
November 2024
Orthopaedics, Virginia Commonwealth University School of Medicine, Richmond, USA.
Distal femoral anterior cortical perforation is a rare complication of intramedullary nailing for proximal femur fractures. Awareness and intraoperative preventive measures are key to minimizing the risk of this complication. We report a case of a patient who experienced an anterior cortical breach of the distal femur during routine antegrade nailing for an intertrochanteric fracture, which was attributed to a sclerotic lesion in the distal femur.
View Article and Find Full Text PDFJ Arthroplasty
December 2024
Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD.
Introduction: In postmenopausal women who are estrogen deficient, hormone replacement therapy (HRT) has been shown to improve fragility fracture risk. However, few studies have examined the relationship between HRT and periprosthetic fracture (PPF) risk after total hip arthroplasty (THA). The purpose of this study was to determine the impact of HRT use on 10-year PPF risk following THA.
View Article and Find Full Text PDFOper Orthop Traumatol
December 2024
Department of Orthopedics and Traumatology, Centre Hospitalier Universitaire Vaudois, (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland.
Objective: Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding.
Indications: Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques.
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