Ulnar bone fracture secondary prevention: Difference between revisions
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==Secondary Prevention== | ==Secondary Prevention== | ||
It should be noted that the Post-menopausal women specially older than the age of 65 are at the higher risk of [[osteoporosis]] consequently these type of patients at greater risk for the pathological [[Bone fracture|fractures]]. | It should be noted that the Post-menopausal women specially older than the age of 65 are at the higher risk of [[osteoporosis]] consequently these type of patients at greater risk for the pathological [[Bone fracture|fractures]] <ref name="pmid28303286">{{cite journal |vauthors=Gierer P, Wichelhaus A, Rotter R |title=[Fractures of the olecranon] |language=German |journal=Oper Orthop Traumatol |volume=29 |issue=2 |pages=107–114 |date=April 2017 |pmid=28303286 |doi=10.1007/s00064-017-0490-z |url=}}</ref><ref name="pmid28664232">{{cite journal |vauthors=Siebenlist S, Braun KF |title=[Elbow dislocation fractures] |language=German |journal=Unfallchirurg |volume=120 |issue=7 |pages=595–610 |date=July 2017 |pmid=28664232 |doi=10.1007/s00113-017-0373-7 |url=}}</ref><ref name="pmid28687098">{{cite journal |vauthors=Levine DG, Aitken MR |title=Physeal Fractures in Foals |journal=Vet. Clin. North Am. Equine Pract. |volume=33 |issue=2 |pages=417–430 |date=August 2017 |pmid=28687098 |doi=10.1016/j.cveq.2017.03.008 |url=}}</ref>. | ||
So the [[Calcium]] and [[vitamin D]] supplementation play important role in increasing the [[Bone mineral density|bone mineral density (BMD]]) consequently decrease the risk of fracture in these type of patients. Also, avoiding excessive [[alcohol]] and quitting [[smoking]] play important role in this regard. | So the [[Calcium]] and [[vitamin D]] supplementation play important role in increasing the [[Bone mineral density|bone mineral density (BMD]]) consequently decrease the risk of fracture in these type of patients. Also, avoiding excessive [[alcohol]] and quitting [[smoking]] play important role in this regard. | ||
=== Detecting osteoporosis: === | |||
*[[Dual energy X-ray absorptiometry|DEXA]](dual-energy x-ray absorptiometry) scan | |||
*Serum [[calcium]] and [[vitamin D]] levels | |||
*[[Medical ultrasonography|Ultrasonography]] of the [[calcaneus]] | |||
=== Pharmacological therapy === | |||
*The primary goal for the treatment of [[osteoporosis]] is to reduce longtime [[fracture]] risk in patients. Increasing [[Bone mineral density|bone mineral density (BMD)]] in response to the treatment is far less important than improvement of clinical aspects of [[osteoporosis]], i.e., [[Osteoporosis|osteoporotic]] [[Bone fracture|fracture]]. Therefore, most of the [[drugs]] efficacy is measured by the extent they improve the [[fracture]] risk instead of increasing [[Bone mineral density|BMD]].<ref name="pmid11893367">{{cite journal |vauthors=Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, Black DM |title=Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs |journal=Am. J. Med. |volume=112 |issue=4 |pages=281–9 |year=2002 |pmid=11893367 |doi= |url=}}</ref> | |||
*During the treatment, if a single [[fracture]] happens, it does not necessarily indicate treatment failure or the need to be started on an alternative treatment or patient referral to a [[specialist]].<ref name="pmid28761958">{{cite journal |vauthors=Ensrud KE, Crandall CJ |title=Osteoporosis |journal=Ann. Intern. Med. |volume=167 |issue=3 |pages=ITC17–ITC32 |year=2017 |pmid=28761958 |doi=10.7326/AITC201708010 |url=}}</ref> | |||
*[[Calcium]] and [[vitamin D]] supplementation have been found to be effective in reducing the long term [[Bone fracture|fracture]] risk, significantly. In order to suggest the people to use [[vitamin D]] and [[calcium]] [[supplements]], the [[physician]] needs to make sure that patient is not able to obtain the [[nutrients]] through the daily intake. The available supplemental ions of [[calcium]] include [[calcium carbonate]], [[Calcium citrate|calcium citrate,]] and [[vitamin D3]] in various [[Dosage form|dosage forms]].<ref name="pmid24131178">{{cite journal |vauthors=Bauer DC |title=Clinical practice. Calcium supplements and fracture prevention |journal=N. Engl. J. Med. |volume=369 |issue=16 |pages=1537–43 |year=2013 |pmid=24131178 |pmc=4038300 |doi=10.1056/NEJMcp1210380 |url=}}</ref> | |||
===Life style modifications=== | |||
*[[Exercise]]: Exercise promotes the [[mineralization]] of [[bone]] and [[bone]] accumulation particularly during growth. High impact exercise, in particular, has been shown to prevent the development of [[osteoporosis]]. However, it can have a negative effect on bone [[mineralization]] in cases of poor [[nutrition]], such as [[anorexia nervosa]] and [[celiac disease]]. | |||
*[[Nutrition]]: A [[diet]] high in [[calcium]] and [[vitamin D]] prevents [[bone loss]]. Patients at risk for [[osteoporosis]], such as persons with chronic [[steroid]] use are generally treated with [[vitamin D]] and [[calcium]] supplementation. In [[Kidney|renal]] disease, more active forms of [[vitamin D]], such as 1,25-dihydroxycholecalciferol or [[calcitriol]] are used; as the kidney cannot adequately generate [[calcitriol]] from [[calcidiol]] (25-hydroxycholecalciferol), which is the storage form of [[vitamin D]]. | |||
*By quitting [[smoking]], [[osteoporosis]] as well as other diseases can be prevented. | |||
*Avoiding excessive [[alcohol]] intake or drinking only in moderation (1–2 alcoholic beverages/day). | |||
*Taking least possible dosages of certain medications that are associated with [[osteoporosis]] ([[anticonvulsants]] or [[corticosteroids]]).<ref name="BuckleyGuyatt2017">{{cite journal|last1=Buckley|first1=Lenore|last2=Guyatt|first2=Gordon|last3=Fink|first3=Howard A.|last4=Cannon|first4=Michael|last5=Grossman|first5=Jennifer|last6=Hansen|first6=Karen E.|last7=Humphrey|first7=Mary Beth|last8=Lane|first8=Nancy E.|last9=Magrey|first9=Marina|last10=Miller|first10=Marc|last11=Morrison|first11=Lake|last12=Rao|first12=Madhumathi|last13=Robinson|first13=Angela Byun|last14=Saha|first14=Sumona|last15=Wolver|first15=Susan|last16=Bannuru|first16=Raveendhara R.|last17=Vaysbrot|first17=Elizaveta|last18=Osani|first18=Mikala|last19=Turgunbaev|first19=Marat|last20=Miller|first20=Amy S.|last21=McAlindon|first21=Timothy|title=2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis|journal=Arthritis & Rheumatology|volume=69|issue=8|year=2017|pages=1521–1537|issn=23265191|doi=10.1002/art.40137}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 00:54, 17 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;
Overview
Early detection and proper management of osteoporosis plays an important role in secondary prevention of ulnar bone fractures.
Secondary Prevention
It should be noted that the Post-menopausal women specially older than the age of 65 are at the higher risk of osteoporosis consequently these type of patients at greater risk for the pathological fractures [1][2][3].
So the Calcium and vitamin D supplementation play important role in increasing the bone mineral density (BMD) consequently decrease the risk of fracture in these type of patients. Also, avoiding excessive alcohol and quitting smoking play important role in this regard.
Detecting osteoporosis:
- DEXA(dual-energy x-ray absorptiometry) scan
- Serum calcium and vitamin D levels
- Ultrasonography of the calcaneus
Pharmacological therapy
- The primary goal for the treatment of osteoporosis is to reduce longtime fracture risk in patients. Increasing bone mineral density (BMD) in response to the treatment is far less important than improvement of clinical aspects of osteoporosis, i.e., osteoporotic fracture. Therefore, most of the drugs efficacy is measured by the extent they improve the fracture risk instead of increasing BMD.[4]
- During the treatment, if a single fracture happens, it does not necessarily indicate treatment failure or the need to be started on an alternative treatment or patient referral to a specialist.[5]
- Calcium and vitamin D supplementation have been found to be effective in reducing the long term fracture risk, significantly. In order to suggest the people to use vitamin D and calcium supplements, the physician needs to make sure that patient is not able to obtain the nutrients through the daily intake. The available supplemental ions of calcium include calcium carbonate, calcium citrate, and vitamin D3 in various dosage forms.[6]
Life style modifications
- Exercise: Exercise promotes the mineralization of bone and bone accumulation particularly during growth. High impact exercise, in particular, has been shown to prevent the development of osteoporosis. However, it can have a negative effect on bone mineralization in cases of poor nutrition, such as anorexia nervosa and celiac disease.
- Nutrition: A diet high in calcium and vitamin D prevents bone loss. Patients at risk for osteoporosis, such as persons with chronic steroid use are generally treated with vitamin D and calcium supplementation. In renal disease, more active forms of vitamin D, such as 1,25-dihydroxycholecalciferol or calcitriol are used; as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol), which is the storage form of vitamin D.
- By quitting smoking, osteoporosis as well as other diseases can be prevented.
- Avoiding excessive alcohol intake or drinking only in moderation (1–2 alcoholic beverages/day).
- Taking least possible dosages of certain medications that are associated with osteoporosis (anticonvulsants or corticosteroids).[7]
References
- ↑ Gierer P, Wichelhaus A, Rotter R (April 2017). "[Fractures of the olecranon]". Oper Orthop Traumatol (in German). 29 (2): 107–114. doi:10.1007/s00064-017-0490-z. PMID 28303286.
- ↑ Siebenlist S, Braun KF (July 2017). "[Elbow dislocation fractures]". Unfallchirurg (in German). 120 (7): 595–610. doi:10.1007/s00113-017-0373-7. PMID 28664232.
- ↑ Levine DG, Aitken MR (August 2017). "Physeal Fractures in Foals". Vet. Clin. North Am. Equine Pract. 33 (2): 417–430. doi:10.1016/j.cveq.2017.03.008. PMID 28687098.
- ↑ Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, Black DM (2002). "Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs". Am. J. Med. 112 (4): 281–9. PMID 11893367.
- ↑ Ensrud KE, Crandall CJ (2017). "Osteoporosis". Ann. Intern. Med. 167 (3): ITC17–ITC32. doi:10.7326/AITC201708010. PMID 28761958.
- ↑ Bauer DC (2013). "Clinical practice. Calcium supplements and fracture prevention". N. Engl. J. Med. 369 (16): 1537–43. doi:10.1056/NEJMcp1210380. PMC 4038300. PMID 24131178.
- ↑ Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake; Rao, Madhumathi; Robinson, Angela Byun; Saha, Sumona; Wolver, Susan; Bannuru, Raveendhara R.; Vaysbrot, Elizaveta; Osani, Mikala; Turgunbaev, Marat; Miller, Amy S.; McAlindon, Timothy (2017). "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis". Arthritis & Rheumatology. 69 (8): 1521–1537. doi:10.1002/art.40137. ISSN 2326-5191.