-
[show abstract]
[hide abstract]
ABSTRACT: Objectives: To investigate the association between sex and parathyroid hormone response to severe vitamin D deficiency after hip fracture. Design: Cross-sectional study. Setting: Rehabilitation hospital in Italy. Participants: 571 consecutive inpatients with hip fracture and severe vitamin D deficiency (serum 25-hydroxyvitamin D < 12ng/ml), without hypercalcemia or estimated glomerular filtration rate (GFR) < 15ml/min. Measurements: In each patient we assessed PTH (by two-site chemiluminescent enzyme-labelled immunometric assay), 25-hydroxyvitamin D (by immunoenzymatic assay), albumin-adjusted total calcium, phosphate, magnesium, and creatinine 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Functional level was assessed using the Barthel index. PTH response to vitamin D deficiency was classified as either secondary hyperparathyroidism (serum PTH >75pg/ml) or functional hypoparathyroidism, i.e., inappropriate normal levels of PTH (≤75pg/ml). Results: Among the 571 patients, 336 (59%) had functional hypoparathyroidism, whereas 235 (41%) had secondary hyperparathyroidism. PTH status was significantly different between sexes (p=0.003): we found functional hypoparathyroidism in 61% of women and 43% of men (secondary hyperparathyroidism in 39% of women and 57% of men). The significance of the between-sex difference was maintained after adjustment for age, estimated GFR, phosphate, albumin-adjusted total calcium, albumin, Barthel index scores, 25-hydroxyvitamin D, and hip fracture type (either cervical or trochanteric). The adjusted odds ratio was 1.85 (95%CI from 1.09 to 3.13; p=0.023). Conclusions: Data shows that PTH response to vitamin D deficiency was sex-associated following a fracture of the hip. The higher prevalence of secondary hyperparathyroidism may play a role in the known prognostic disadvantage found in hip-fracture men.
The Journal of Nutrition Health and Aging 01/2013; 17(2):180-4. · 2.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Few studies focused on fall prevention in hip-fracture survivors.
To investigate the role of adherence to targeted recommendations on both home environment and behaviors in affecting the hazard of falling after a fall-related hip fracture.
Post-hoc analysis of a quasi-randomized controlled trial.
Post-acute rehabilitation hospital.
Ninety-five of 119 women living in the community with a fall-related fracture of the hip.
We assessed home hazard of falling and suggested targeted modifications of home environment and behaviors in activities of daily living to prevent falls during inpatient rehabilitation. Falls were recorded at a six-month follow-up during a pre-planned home visit.
Nineteen of the 95 women sustained at least one fall during the six-month follow-up. Women with > 2 uncorrected risk factors had a significantly higher risk of falling than those with 0-2 risk factors; the odds ratio adjusted for four confounders was 4.58 (95%CI 1.472-4.250; P=0.009). Adherence to recommendations for fall prevention was negatively associated with fall risk. The adjusted odds ratio for a ten percent increase in adherence rate was 0.749 (95%CI 0.594-0.945; P=0.015).
Uncorrected environmental and behavioral risk factors and poor adherence to targeted recommendations for fall prevention significantly predicted the risk of falling in community-dwelling women who sustained a fall-related hip fracture.
Fall-risk assessment should be performed during inpatient rehabilitation following a fall-related hip fracture. Improving adherence to targeted recommendations emerges as a major goal to prevent falls in hip-fracture survivors.
European journal of physical and rehabilitation medicine 07/2011; 48(1):9-15. · 1.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Total hip arthroplasty (THA) has revolutionized the care of patients with end-stage joint disease, leading to pain relief, functional recovery, and substantial improvement in quality of life. However, long-term studies indicate persistence of impairment and functional limitation after THA, and the optimal rehabilitation protocols are largely unknown. The aim of this paper was to systematically review the controlled trials published on the effectiveness of physical exercise programs after THA. Nine studies were retrieved from MEDLINE and reviewed. Results show that the physical exercise protocols most frequently used after THA in the early postoperative phase are neither supported nor denied by clinical controlled trials. Convincing evidence for the effectiveness of single interventions in addition to usual exercise programs exists for each of the three following options: treadmill training with partial body-weight support, unilateral resistance training of the quadriceps muscle (operated side), and arm-interval exercises with an arm ergometer. In the late postoperative phase (operation interval > 8 weeks) exercise programs consistently improve both impairment and ability to function. Weight-bearing exercises with hip-abductor eccentric strengthening may be the crucial component of the late-phase protocols. Substantial limitations were found in the nine studies, including small sample size, patient selection, heterogeneity of outcome assessments, and potential sources of variability not investigated. Despite limitations, we conclude that three main suggestions emerge from controlled trials on physical exercise after THA: early postoperative protocols should include additive interventions whose effectiveness has been shown. Late postoperative programs are useful and should comprise weight-bearing exercises with hip-abductor eccentric strengthening.
European journal of physical and rehabilitation medicine 03/2009; 45(3):303-17. · 1.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate differences in the functional outcome between women sustaining cervical or trochanteric fractures of the hip.
We studied 684 of 736 women admitted consecutively to a rehabilitation hospital in Italy because of their first hip fracture. Functional recovery was assessed by using Barthel index scores. Fractures were classified as either cervical (n=335) or trochanteric (n=349) on the basis of surgical and radiographic findings.
After acute in-patient rehabilitation, women with trochanteric fracture had a significantly lower Barthel index score than women with cervical fracture (median values were 85 and 90 respectively, interquartile ranges were 25 and 30 respectively, P=0.001). Length of stay in the hospital was significantly longer in women with trochanteric fractures (median was 37 days vs 36 days; interquartile range was 10 days vs 8 days, P=0.018). However, the differences between the two groups were no longer significant after adjustment for eight variables that affect functional ability in the same population (i.e., age, pressure ulcers, cognitive impairment, neurologic impairment, infections during the length of stay, bone mineral density, body mass index, and Barthel index scores assessed before rehabilitation). Further-more, we found no significant differences in the change of Barthel index scores during rehabilitation and in Barthel index efficiency (change in the Barthel index score after rehabilitation divided by the length of stay in hospital) between the two groups of women.
After adjustment for several confounders, we did not show significant differences in the functional outcome between women with cervical or trochanteric fracture of the hip.
Europa medicophysica 01/2008; 43(4):439-44.
-
[show abstract]
[hide abstract]
ABSTRACT: Many observations support the view that there are significant differences between patients sustaining trochanteric fractures and those sustaining cervical fractures of the hip. Our aim was to evaluate the association between soft tissue composition (fat and lean compartments) and the type of hip fracture sustained. Of 120 consecutive women affected by their first hip fracture admitted to our rehabilitation hospital 102 were included in this cross-sectional study. Body composition was assessed by DXA. Body fat mass was lower in the women with trochanteric fracture than in those with cervical fracture (difference between groups: 2.86 kg; 95% CI 0.10-5.61 kg; p=0.042). The percentage of fat was 30.75+/-8.77 (mean+/-SD) versus 34.75+/-7.29 (difference between groups: 4.00; 95% CI 0.84-7.16; p=0.014). In contrast, no meaningful differences in body lean mass were shown between the two groups. Logistic multiple regression showed that fat mass was associated with the type of fracture independently of age, height, weight, time between fracture occurrence and DEXA assessment, comorbidity, number of drugs in use, lean mass and bone mineral content. The logistic regression results were similar when fat percentage was substituted for fat mass. The data show that fat but not lean body mass is associated with the type of hip fracture, contributing to the definition of the differences between patients sustaining cervical or trochanteric fractures. We stress the importance of distinguishing the two types of fracture when clinical or epidemiological studies related to body composition, including those regarding nutrition or physical exercise, are performed.
Clinical Rheumatology 03/2004; 23(1):6-10. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fat body mass (FBM) is a strong predictor of both bone mineral density (BMD) and risk of hip fracture, but the mechanisms responsible are not completely understood. We addressed whether leptin is the link between FBM and BMD in hip-fractured women. Sixty-two of 74 women with hip fractures were evaluated. Serum leptin was measured by radioimmunoassay, 23.4+/-9.1 days (mean+/-SD) after fracture occurrence. BMD and body composition were assessed by dual-energy X-ray absorptiometry (DXA). As expected, a positive linear correlation was found between FBM and both leptin (r=0.782; p<0.001) and femur BMD measured at five sites (r value ranging from 0.293 to 0.498 depending on the site of the femur BMD assessment, p<0.05). A positive correlation between leptin and BMD measured at the intertrochanteric area (r=0.259; p<0.05) but not at the other four sites was shown. At linear multiple regression [dependent variable = femur BMD; independent variables = age, weight, height, body mass index, fracture type, term fracture-DXA, Barthel index score, FBM, lean body mass, serum PTH, serum 25(OH)vitamin D and leptin], FBM was positively associated with BMD measured at all the five sites. The association between leptin and BMD was inverse and it was significant at four of the five sites of the BMD assessment. In conclusion, in a sample of hip-fractured women, the positive association between FBM and femur BMD was not explained by serum leptin. On the contrary, after adjustment for FBM and other confounding variables, an inverse association between leptin and BMD was found.
Journal of endocrinological investigation 12/2003; 26(12):1180-5. · 1.57 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: During 1996, 585 patients, aged 55 to 96, were admitted into hospital at the Geriatric Department of Ospedale Maggiore (Turin). Acute confusion was seen in 22.2% of these patients who tended to have more serious clinical condition, were more likely to have chronic cognitive impairment, were treated with a greater number of drugs and suffered more from immobility with pressure ulcer. The confusional state, manifested at admission to Geriatric department, was mostly related with the patient's clinical severity, while the one which developed during hospital stay was linked to situations of physical frailty, as pressure ulcer and low albumin values. The most frequent causes of acute confusional state were acute infectious diseases, heart failure, gastro-intestinal bleeding with secondary anaemia, stroke and dehydration. In many cases the very cause of the acute confusional state could not be identified. Falls, more than 31 days length of stay in hospital and death were more frequent in patients suffering from confusional state. Chronic cognitive impairment, functional dependence, clinical severity and treatment involving a great number of drugs, are the main contributing factors in this syndrome. Thus, a multi-dimensional evaluation which takes into account both clinical-functional and socio-economical aspects, is useful for a correct preventive and diagnostic approach of acute confusional state.
Recenti progressi in medicina 06/1998; 89(5):229-34.
