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Guidelines for the management of osteoporosis and fragility fractures.

The purpose of this document, a result of the harmonisation and revision of Guidelines published separately by the SIMFER, SIOMMMS/SIR, and SIOT associations, is to provide practical indications based on specific levels of evidence and various grades of recommendations, drawn from available literature, for the management of osteoporosis and for the diagnosis, prevention, and treatment of fragility fractures. These indications were discussed and formally approved by the delegates of the Italian Scientific Associations involved in the project (SIE, SIGG, SIMFER, SIMG, SIMI, SIOMMMS, SIR, and SIO

The Clots in Legs Or sTockings after Stroke (CLOTS) 3 trial: a randomised controlled trial to determine whether or not intermittent pneumatic compression reduces the risk of post-stroke deep vein thrombosis and to estimate its cost-effectiveness.

BACKGROUND: Venous thromboembolism (VTE) is a common cause of death and morbidity in stroke patients. There are few data concerning the effectiveness of intermittent pneumatic compression (IPC) in treating patients with stroke. OBJECTIVES: To establish whether or not the application of IPC to the legs of immobile stroke patients reduced their risk of deep vein thrombosis (DVT). DESIGN: Clots in Legs Or sTockings after Stroke (CLOTS) 3 was a multicentre, parallel-group, randomised controlled trial which allocated patients via a central randomisation system to IPC or no IPC. A technician blind

Comparative Outcomes in Metastatic Spinal Cord Compression and Femoral Metastatic Disease: Distinct Clinical Entities with Divergent Prognoses?

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient's quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic emergencies, addressing whether they represent sequential disease stages or distinct patient subpopulations-an analysis critical for prognosis and treatment planning. Materials and Methods: Records of all patients who underwent surgery for a femoral metastatic disease (FMD) over a

Adefovir dipivoxil-induced hypophosphatemic osteomalacia and osteoporosis: a case report and literature review.

The nephrotoxicity of adefovir dipivoxil (ADV) can induce Fanconi syndrome, which causes hypophosphatemic osteomalacia. We report a case of a 67-year-old postmenopausal woman who had been receiving long-term adefovir dipivoxil therapy for chronic hepatitis B. She presented with severe bone pain and multiple pseudofractures, and was diagnosed with drug-induced hypophosphatemic osteomalacia. Following discontinuation of adefovir and supplementation with vitamin D and phosphate, her biochemical parameters normalized and bone pain significantly improved, indicating that osteomalacia had been essen

Risk Factors and Impact on Survival of Pathological Fractures in Patients With Humeral Metastasis.

Background Bone metastases often cause pathological fractures and impair patients' quality of life and survival. Although several studies have been conducted on pathological fractures in the femur and spine, limited research has been done on the upper limbs. This study aimed to reveal the risk factors and determine how pathological fractures impact survival in patients with humeral metastasis. Methods This retrospective study was based on patients with humerus metastasis treated in the Nagoya-City University Hospital from 2010 to 2020. Patient characteristics, including sex, age at diagnosis o

Risk Factors for Early Postoperative Morbidity and Mortality following Extremity Metastatic Pathologic or Impending Fracture Fixation.

BACKGROUND: As cancer survivorship continues to improve, the perioperative morbidity and mortality following surgical treatment of metastatic bone disease become an increasingly important consideration. The objective of this study is to identify risk factors for early postoperative complications and mortality following extremity prophylactic fixation and pathologic fracture stabilization. METHODS: A single-centre retrospective review of 185 patients (226 total surgeries) who underwent prophylactic fixation or pathologic fracture stabilization for extremity metastatic bone disease between 2005

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… Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation. International Orthopaedics . 2011;35(10):1537–1543. doi: 10.1007/s00264-010-1160-z. 37. Weiss R. J., Tullberg E., Forsberg J. A., Bauer H. C., Wedin R. …

Principles of Management of Extremity Skeletal Metastasis.

Understanding the epidemiology of extremity skeletal metastasis and the factors deciding the treatment decision-making are essential in developing a diagnostic and treatment strategy. This leads to optimum care and reduces disease-related burden. With the evolution of medical, radiation therapy, and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. Based on the currently available literature, we have described a step-wise evaluation and management strategy of metastatic extremity bone d

Outcomes and prognostic factors after surgery for bone metastases in the extremities and pelvis: A retrospective analysis of 140 patients.

BACKGROUND: Surgical therapy of bone metastases is becoming increasingly important due to prolonged life expectancy and improved oncological treatment options. In a mostly palliative approach, it is necessary to identify those patients who might benefit from surgery. The shorter the remaining lifetime, the more restricted the indication and the less radical the intervention should be. The aim of this study was to evaluate the postoperative outcomes and prognostic factors for survival of patients with surgically treated bone metastases. METHODS: We retrospectively included 140 patients who und

Ambulation Recovery After Surgery for Metastases to the Femur.

BackgroundPostoperative ambulation recovery after surgery for femur metastases has significant implications for not only the patient's quality of life but also administration of further cancer treatment. Thus, identification of preoperative predictors of ambulation recovery is necessary to set appropriate expectations and guide treatment. This study aimed to assess ambulation recovery rate and identify predictors of ambulation recovery in patients undergoing surgery for femur metastases.Materials and methodsA total of 244 patients who underwent surgery for femur metastases at our institution w

Carbon fibre PEEK versus titanium cephalomedullary nails for management of oncological lesions of the femur: a retrospective cohort study.

BACKGROUND: Carbon fibre reinforced polyetheretherketone (CF-PEEK) intramedullary devices have been gaining traction in the field of orthopaedic oncology. We aim to investigate the safety and efficacy of this device. METHODS: A retrospective cohort study was performed. Our primary objectives were to compare all-cause revision and the incidence of postoperative complications between CF-PEEK nails (Group 1) to titanium alloy nails (Group 2) for management of oncological lesions of the femur. Secondary objectives were to compare estimated blood loss and all-cause mortality between the two groups

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… Clinical outcomes of proximal femoral fractures treated with a novel carbon fiber-reinforced polyetheretherketone intramedullary nail. Injury. 2020;51(3):678–82. Epub 20200108. 21. Piccioli A, Piana R, Lisanti M, Di Martino A, Rossi B, Camnasio F, et al. …

Understanding and Managing Fracture Risk in Patients With Cancer: A Literature Review.

One of the most important complications of cancer and its treatments is the increased fracture risk. Fractures can have a significant impact on the patient's quality of life and may be associated with morbidity, mortality, and reduced functional status. The present study aims to investigate the mechanisms underlying the increased risk of fractures in cancer patients, the effect of cancer treatments on fracture risk, and strategies to prevent fractures in this population. This is a literature review using the PubMed - National Center for Biotechnology Information (NCBI), Web of Science, Cochran

Predicting Pathological Fractures at Metastatic Humeral Lesions.

UNLABELLED: The humerus is the second most common site of metastatic disease involving long bones, yet it is still unclear which patients are at high risk for a fracture and may require prophylactic surgical fixation. The goal of this study was to assess the validity of the Mirels score to predict fractures of metastatic lesions in the humerus. METHODS: We performed a retrospective electronic chart review of patients with humeral metastases at our institution (2005 to 2021), with 188 patients meeting the inclusion criteria. Sixty-one of the patients developed a fracture during follow-up. The

Pathological Fractures in Rare Bone Diseases: Clinical Cases.

Rare bone diseases, though uncommon, present significant diagnostic and therapeutic challenges due to their clinical variability and overlapping symptoms with more prevalent conditions. This article describes a clinical case series of three patients with bone fragility fractures caused by rare bone diseases - primary hyperparathyroidism with brown tumor, Gorham-Stout disease, and alkaptonuria - treated at the Department of Orthopedic and Traumatology of Pisa University Hospital between 2018 and 2023. Each case highlights the diagnostic complexities, including inconclusive biopsies, nonspecific

Злоумышленные преобразования у пациентов с моноклонной гаммопатией неизвестного значения, обработанных терипаротидом для остеопороза: ретроспективное исследование двухцентра и анализ французской национальной базы данных о фармакологической бдительности.

UNLABELLED: Была проведена оценка злокачественных трансформаций у пациентов с моноклональной гаммопатией неопределенного значения, обработанных терипаратидом. Среди 29 только пациенты two Перешел к гематологическому искусству.one Множественная миелома, one Макроглобулинемия Уолденстрёма). Эти выводы обнадеживают и свидетельствуют о том, что ТПТ может оставаться одним из вариантов для отдельных пациентов с тяжелым остеопорозом и MGUS. ЦЕЛЬ: Остеопороз является широко распространенным заболеванием костей с ограниченными терапевтическими возможностями, особенно у пациентов, страдающих множественн

Are we underestimating pathological fracture risk in malignant bone lesions of the proximal humerus?

OBJECTIVE: This study is aimed at evaluating the distribution of metastatic bone disease (MBD), with a particular focus on the humerus, and its association with pathological fractures. Factors for contributing to the underestimation of fracture risk were assessed, including their impact on surgical management. MATERIALS AND METHODS: We retrospectively reviewed patient records of patients undergoing surgical treatment for MBD at our institution between 2005 and 2023. The analysis included factors such as medical history, tumour type, metastatic status, surgical method, lesion location, and ima

Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review.

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and s

The role of postoperative radiation and coordination of care in patients with metastatic bone disease of the appendicular skeleton.

Metastatic bone disease affects approximately 300,000 people in the United States, and the burden is rising. These patients experience significant morbidity and decreased survival. The management of these patients requires coordinated care among a multidisciplinary team of physicians, including orthopaedic surgeons. This article reviews the role of radiation therapy after orthopaedic stabilization of impending or realized pathologic extremity fractures. Orthopaedic surgeons have an opportunity to benefit patients with metastatic bone disease by referring them for consideration of post-operativ

Survival and functional outcomes following surgical repair of pathological fractures in dogs: A meta-analysis.

BACKGROUND: Pathological fractures result from abnormal bone remodeling caused by local bone lesions, such as malignant tumors, compromising bone strength. Tumor-derived factors disrupt the balance between bone resorption and formation, leading to osteolytic and osteosclerotic lesions that weaken bone integrity. While surgical treatments, including limb amputation and limb-sparing surgery, are commonly used, the therapeutic efficacy of fracture repair remains unclear due to limited evidence. AIM: This study characterized pathological fractures and evaluated survival time and functional progno

EVALUATION OF QUALITY OF LIFE IN PATIENTS TREATED FOR METASTATIC DISEASE OF THE PROXIMAL FEMUR.

OBJECTIVE: Patients with metastatic bone lesions have a limited life expectancy. These metastatic lesions compromise the proximal femur, and fractures are quite common. The survival of these patients depends on the behavior of the primary tumor. The aim of this study was to evaluate the quality of life of patients with extensive metastatic lesion of the proximal femur with pathological or imminent fracture, treated with non-conventional endoprosthesis. METHODS: From May 2008 to August 2012, twenty-five (25) patients with bone metastases of the proximal femur, with pathological or imminent fra

European guidance for the diagnosis and management of osteoporosis in postmenopausal women.

UnlabelledGuidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk of fractures due to osteoporosis.IntroductionThe International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2008. This manuscript updates these in a European setting.MethodsSystematic literature reviews.ResultsThe following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fr