SP - BMR (Bone

Introduction:

Mortality after a hip fracture increases compared to the general population. The main objective of this study is to examine the incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures.

Methods:

This is a retrospective cohort study from a South American hospital. Patients older than 65 years with osteoporotic hip fracture between 2015 and 2018 were identified. Demographic data and comorbidities were obtained. The incidence rate, standardized mortality rate, trend (Poisson regression), and risk (hazard ratio) were calculated.

Results:

A total of 304 patients admitted for osteoporotic hip fracture were found, 240 (79%) were women with a mean age of 81.3 years (SD 8.45) and 64 (22.1%) were men with a mean age of 85. .42 years (SD 10.08). The cumulative incidence of mortality was 72.5%. The annual mortality rate was 75.6/1000 patients/year (54.8 in men and 20.8 in women). The 1-year mortality rate increased significantly by 2% per year (HR 1.05, 95% CI 1.002–1.08). Median overall survival was 854 days (95%CI 802-906). The mortality probability density was 18% for women and 27% for men (first 90 days).

Conclusions:

A more significant increase in mortality was observed in men than in women. Institutionalization combined with comorbidities are associated with higher mortality.

Introduction

The SARC-F questionnaire can be rapidly implemented by clinicians to identify patients with probable sarcopenia. A score ≥4 is predictive of sarcopenia and poor outcome. We sought to identify the prevalence and demographic correlates of probable sarcopenia (SARC-F score ≥4) in community-dwelling older adults.

Methods

480 participants (219 men, 261 women) identified from Primary Care completed a questionnaire ascertaining demographic, lifestyle factors, comorbidities, nutrition risk score (DETERMINE) and SARC-F score. Participant characteristics in relation to probable sarcopenia were examined using sex-stratified logistic regression. Age was included as a covariate.

Results

The median (lower quartile, upper quartile) age was 79.8 (76.9, 83.5) years. 12.8% of men and 23% of women had probable sarcopenia. Self-reported walking speed strongly associated with probable sarcopenia (men: odds ratio (OR) 10.39 (95% CI: 4.55, 23.72), p<0.001; women: 11.42 (5.98, 21.80), p<0.001 per lower band). Older age was associated with probable sarcopenia in both sexes (p=0.01) as was higher DETERMINE score (men: 1.30 (1.12, 1.51), p=0.001; women: 1.32 (1.17, 1.50), p<0.001 per unit increase). Among men, being married or in a civil partnership or cohabiting was protective against probable sarcopenia (0.39 (0.17, 0.89), p=0.03) as was reporting drinking any alcohol (0.34 (0.13, 0.92), p=0.03) while in women generally similar relationships were seen though these were weaker. Higher BMI (1.14 (1.07, 1.22), p<0.001 per unit increase) and presence of comorbidities (1.61 (1.34, 1.94), p<0.001 per extra medical condition) were also associated with probable sarcopenia in women. All associations were robust after adjustment for age.

Conclusions

Probable sarcopenia (SARC-F score ≥4) was common in older adults living in their own homes. As expected, self-reported walking speed was highly predictive of probable sarcopenia. In addition to advancing age and malnutrition, socio-demographic factors were also important. Identifying these factors in clinical practice should trigger sarcopenia screening in older adults.

Introduction

Orthopaedic surgery is an important treatment for musculoskeletal (MSK) conditions. In the NHS, 25% of all surgical interventions are for MSK conditions and account for 16.1% of the total cost of surgery. Complications following joint surgery include venous thromboembolism, infection, stroke, myocardial infarction, falls and delirium. Remote ischaemic conditioning (RIC) is a technique which induces intermittent ischaemia of a limb, through inflating a tourniquet above systolic blood pressure for intervals that avoid physical injury but trigger several intrinsic protective mechanisms.

Method

A systematic literature search was performed in Pubmed, Medline and Embase for studies investigating RIC in fracture, trauma or orthopaedic surgery, published between 1966 and November 2023. Pre-clinical trials and clinical randomised controlled trials (RCTs) were included. There was insufficient data to conduct meta-analyses, so a narrative review was undertaken. PEDro risk of bias scale was performed on RCTs.

Results

Three pre-clinical trials studied RIC in animal models. Results showed a reduction in markers of oxidative stress and up-regulation of genes involved in osteoblast expression, causing improved fracture healing. 20 clinical RCT manuscripts considered the used of RIC in elective and emergency orthopaedic surgery. In total, 1276 participants were studied, and protocols used one dose of RIC prior to surgery. 17 studies demonstrated statistically significant positive outcomes in RIC compared to control, including known mechanisms of RIC such as oxidative stress, inflammation and oxygenation. Additionally, when measured, post-operative pain was improved and there were fewer cardiovascular complications in at-risk individuals.

Conclusions

There is evidence that RIC has a positive effect in orthopaedic surgery, however the populations and outcomes measured were varied. Repeated use of RIC, including post-operative doses, may result in more profound beneficial effects. There is a need for designed RCTs to test whether this intervention can improve the clinical outcomes in wider populations.

Introduction:

Older people represent between 21 to 40% of Emergency Department (ED) users and proportionally use more ED services than any other age group. A Geriatric Ambulatory care service, in collaboration with Emergency Department, was initiated to achieve earlier identification and interventions for frail patients with geriatric syndromes.

Methodology:

Retrospective review was undertaken from 13th January 2022 until 23rd December 2022 in older patients discharged from the ED ambulatory area following a targeted geriatric assessment and recommended follow-up interventions at the geriatric clinic or day hospital. Two groups were identified, those compliant to follow-up interventions (GpC) and those that defaulted (GpD).

Demographic information, functional ability, hospital utilisation and mortality (up to one year), and any post-visit fragility fractures were reviewed. Data collection included identification of osteoporosis or osteopenia and cognitive decline during or following the visit and findings were compared across the 2 groups. Odd Ratios (ORs) with 95% Confidence Intervals (CIs) are provided as appropriate. All statistical analyses were performed using a two-tailed test with a significance level of p<0.05.

Results:

137 patients were reviewed, and 79 patients (58%) compliant to geriatric follow-up (GpC) and 58 patients (42%) non-compliant (GpD). Age and sex were similar, 80 vs 80 years, range 65-98 years and female s 58% vs 62%. BADL was 16.98 vs 18.42, range 4-20 and iADL 4.48 vs 5.02, range 0-7.

ED 7-day re-attendances were similar, 9% vs 12%, p=0.578 but 30-day hospital admissions were lower 10% vs 16%, p=.434, although 1 year ED attendances were higher in the compliant group, 56% vs 45%, p=0.230, which did not translate to more 1 year hospital admissions 35% vs 36%, p=1.000. Mortality was 12% vs 16%, p=.611.

More patients were identified as having osteoporosis 23% vs 21% or high-risk osteopenia 14% vs 9%, p=<001 and a larger number of patients had unevaluated bone health in the non-compliant group 27% vs 47%, p=<0.001. However, fragility fractures were similar, 9% vs 7%, p=0.758. AMT was 7.94 vs 5.02, range 0-10 and cognitive impairment identified in 43% vs 33%, p=0.001, with dementia in 28% vs 10%, p=.0001, Mild Cognitive Impairment in 15% vs 7%, p=.000.1 and suspected but not evaluated in 0% vs 12%, p=0.001

Introduction:

The kinin-kallikrein system has been implicated in muscle performance: bradykinin promotes glucose uptake and blood flow in muscle through bradykinin receptor 2 (BDKRB2). BDKRB2 variants include rs1799722 and rs5810761, where the T and -9 alleles respectively have associated with increased transcriptional rates and were overrepresented in endurance athletes. However, these variants have rarely been studied among older people or those with sarcopenia.

Methods:

The Leucine and ACE inhibitor (ACE) trial enrolled 145 participants aged ≥70 years with low grip strength and low gait speed. Participants’ blood samples had DNA extracted and were genotyped for rs179972 using TaqMan and rs5810761 by amplification through Hotstar Taq (and visualised through 4% agarose gel electrophoresis). The differences in genotypes for each variant against physical performance measures (e.g. six-minute walk distance [6MWD]) was calculated using t-tests or Mann-Whitney tests where appropriate. Genotypes were also tested for Hardy-Weinberg equilibrium (HWE) using Chi-squared test.

Results:

Data from 136 individuals were included in the analysis. For rs1799722, the genotype frequency (TT: 17, CC: 48, CT: 71) remained in HWE (p=0.248). No difference between TT and CC/CT group was seen for 6MWD, grip strength or SPPB. Among men, the TT genotype had greater 6MWD compared to CC/CT (400m vs 312m, p=0.007), and also greater leg muscle mass (17.6kg vs 15.3kg, p =0.005), but no difference was noted in women. For rs5810761, the genotype frequency (-9-9: 31, +9+9: 43, -9+9: 60) also remained in HWE (p=0.269). No difference between -9-9 and +9+9/+9-9 was seen for 6MWD, grip strength or SPPB. In men, but not women, -9-9 genotype had reduced arm fat baseline (1.85kg vs 2.72kg; p=0.005).

Conclusion: Among men, the TT genotype was associated with longer 6MW distance and higher leg muscle mass. The -9-9 genotype was associated with lower regional fat mass in men.

Background

Dietary nitrate (inorganic nitrate) supplementation has been proposed as an intervention to improve muscle function via increased nitric oxide (NO) availability. Although some studies show benefit in younger adults, the effectsin older people are unclear. This systematic review evaluated the effects of dietary nitrate supplementation on physical performance and muscle strength measures in older people.

Method

The review was conducted according to a prespecified protocol by two reviewers. We included interventional studies using dietary nitrate supplementation, mean participant age 60 and over, with or without sarcopenia or impaired physical performance. Outcomes of interest were physical performance and measures of muscle strength and mass. Risk of bias was assessed using a structured tool. Results were grouped by intervention and outcome measures and were described by narrative synthesis.

Results

Our search strategy found 1174 titles; 25 studies were included in the review. Study size ranged from 8 to 72 participants. Data on baseline functional status were not available, but 7 studies were in healthy older adults. The intervention duration ranged from a single dose to twelve weeks. Most studies had high or unclear risk of bias; three had low risk of bias. One hundred and nineteen outcomes were reported; 62 were physical performance measures and 57 were muscle strength measures. Twenty-nine outcomes showed significant improvement, two showed significant worsening and 88 showed no statistically significant difference. Results that showed significant improvement did not group together under any particular outcome measure, supplementation product or duration. Meta-analysis was not possible due to heterogeneity of populations, intervention duration and outcome measures.

Conclusion

Current evidence suggests that increasing intake of dietary nitrates may be beneficial for physical performance and muscle strength in older people, however data are limited. Future studies should be longer, larger and target older people with sarcopenia or impaired physical performance.

Introduction: Hip Fracture Surgery (HFS) can result in balance impairment which is associated with an increased risk of falls in the elderly as well as limitations in their mobility. Balanced Training (BT) is a rehabilitation method used aiming to minimize the balance impairments post HFS. BT options include stepping, balance task-specific exercise, standing on one leg, yoga.

Our main outcome is to evaluate the effect of BT on the physical functioning of elderly patients post an HFS.

Methods: We conducted a systematic review using the PubMed-Medline, Cochrane Library and Embase databases to locate randomized controlled trials which compared BT with standard care post HFS. The Cochrane’ Library Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used as our template for the review.

Results: Overall, nine randomized controlled trials were selected, comprising a total of 712 patients, all aged 65 years of age and older. With regards to the type of BT rehabilitation: four trials used step-ups (n=500), three trials used balance task-specific exercise (n=170) and two studies used standing on one leg (n=42). The BT group demonstrated improvement in physical functioning post HFS compared to the control group (Standardized Mean Difference (SMD) = 0.410). Moreover, all functional parameters which include, lower limb strength, performance task and health related quality of life, were also improved in the BT group.

Conclusion: Evidently, the results demonstrate an improvement of physical functioning by BT post HFS. Furthermore, the positive effects on all functioning parameters were apparent. As a result, the implementation of BT in postoperative rehabilitation programs in elderly patients with hip fractures should be considered. References: Monticone M, Ambrosini E, Brunati R, et al. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil. 2018;32:340–351