key: cord-0252555-r9qjf7mg authors: nan title: 3(rd) Panhellenic Conference of Fragility Fracture Network Greece (FFN GR) “Necessity of Interdisciplinarity and Networking” date: 2022 journal: J Musculoskelet Neuronal Interact DOI: nan sha: 0e415b864c0c438d2db0b971e432540289ed3b52 doc_id: 252555 cord_uid: r9qjf7mg nan Dimitrios Begkas 1 , Stamatios-Theodoros Chatzopoulos 1 Bisphosphonates (BPs) are the most commonly used antiresorptive osteoporosis medications. However, there have been concerns about their negative effects on fracture healing as they may inhibit bone remodeling and delay fracture union due to osteoclast inhibition. The purpose of this study was to investigate the effects on fracture healing of BP administration before intramedullary nailing (IMN) of intertrochanteric femoral fractures (IFF). We retrospectively analyzed data from 350 patients who underwent IMN for osteoporotic IFF during the period between 2013 and 2018. Patients were divided into two groups (A and B). Group A (n=125) included those who had previously received BPs for at least 3 months prior to IMN. Group B (n=225) included all patients who had not received BPs. Evaluation of fracture healing outcomes in both groups was based on radiological (callus formation in plain radiographs 3, 6 and 12 months after IMN) and clinical (change in Koval score before and 1 year after IMN) criteria. Three, 6 and 12 months after IMN, fracture healing was achieved in 72.8% (91/125), 90.4% (113/125) and 92.8.6% (116/125) of patients, respectively, in group A and in 90.7% (204/225), 94.2 (212/225) and in 96.9% (218/225) of patients, respectively, in group B. The change in Koval score was of the order of 0.1 (from 1.2 before IMN to 1.1 one year after IMN; p=0.69). Multivariable logistic regression analysis revealed that a history of BP administration was associated with an increased risk of delayed union at 3 months postoperatively (P=0.016). Preoperative BP administration was associated with a reduced rate of fracture healing 3 months after IMN, compared with patients who had not received BPs. Therefore, patients who have previously been treated with BPs should leave walking aids with extreme caution and gradually and very carefully switch to full weight during the early postoperative period. Introduction: Swallowing impairments (SI)/dysphagia are a common well-documented symptom in the elderly 1 . Patients admitted to hospitals with fractures are likely to get diagnosed with SI. These symptoms are probably not typically associated with new onset dysphagia due to the main reason for admission, but much more with an already existing condition 2 . Little is known about the concurrent comorbidities that might lead to SI or changes in the nutritional status before, during and after hospitalization in this population. The aim of the study was to investigate which concurrent comorbidities are leading to changes in nutritional and swallowing severity of elderly patients with hip/femur fractures. In this prospective cohort study over a 1-year period (01/2020-01/2021), 151 patients with hip/femur fractures consecutively admitted to the regional hospital (mean age 83.9±8 years, 76,8% female) were included. Regarding the outcome measures, all patients were submitted to assessment of their cognitive status using the Mini Mental State Examination (MMSE) 3 , the nutritional profile of the patients -Mini Nutritional Assessment Scale (MNA) 4 , the level of anxiety and depression -Hospital Anxiety and Depression Scale 5 . The different symptomatology of the patients was captured and grouped based on patients' comorbidities: respiratory, neuropsychiatric, neurological, heart dysfunction, gastrointestinal, metabolic, urological, oncology, musculoskeletal. For the assessment of the level of dysphagia severity, Dysphagia Severity Rating Scale (DSRS) 6 was used and for the oral intake, the Functional Oral intake scale (FOIS) 7 . Data regarding the hospital length of stay of the patients was also measured and presented in days. Non-parametric comparisons (Mann-Whitney) and correlations (Spearman's) were employed (SPSS 22.0). : 151 patients were included and data was collected from their admission onwards (Table 1) . 76.8% were female, the average age of the group was 83.9 years. More than half had a MMSE below 21 showing the presence of mild dementia and about 15% had more than 5 concurrent comorbidities. The most common were metabolic and heart diseases. 52.3% were at risk of malnutrition, 41% were malnourished, while only 6.5% of the patients had a normal nutritional status. Finally, almost 10% of the 151 patients had a FOIS lower than 5, while for 19 patients Fiberoptic Examination of Swallowing (FEES) was conducted as they exhibited overt symptoms of dysphagia. In our study we included 91 patients with hip fracture that were admitted in our department. Their clinical status was recorded preoperatively using different clinical assessment tools for sarcopenia and frailty (Sarc-F, Prisma -7, Clinical Fagility Scale), nutrition (Mini Nutritional Assessment -MNA), mobility state (New Mobility Score), mental state (AMMT-S, AMT-4, 4-AT), health state (ASA score, Charlson Index Score), quality of life (EQ-5D) and mortality (Nottingham Hip Fracture score and Sernbo score). Complications were also recorded and all data were analyzed. • The increase in the age limit observed in recent years, as a result of the improvement of medical care, has led to an increase in dementia fragility fractures. • To this day, it has not been clarified whether dementia is the cause of fragility fractures or whether there is a two-way relationship between the two conditions. • What is certain, however, is that both of these conditions present significant morbidity and mortality in the elderly and together constitute a significant public health problem 2 . • Falls in the elderly are a major public health problem, especially in terms of morbidity, mortality and treatment costs. • 28-35% of people over the age of 65 experience at least one fall per year and this rate increases to 32-42% for people over the age of 75 (approximately 17 million Europeans). • 40-60% of falls cause injuries to patients of which 30-50% are mild, 5-6% severe and 5% are fractures (1/5 are hip fractures). • 50% of people over the age of 80 will experience at least one fall and this is three times more common in people who stay in rest homes for a long time 3 . The incidence of hip fractures in patients with dementia is up to three times higher than in older adults without dementia and there are many pathways involved in this increased risk. • Factors affecting the treatment of osteoporotic fractures in the elderly are bone quality, patient level of cooperation, stability of osteosynthesis and progressive postoperative mobilization. • The rehabilitation team encourages early mobilization and self-service of the patient and prevents prolonged bed rest and dependence on third person 1, 4 . • Reduce the pain. • Increase or maintain the range of movement, muscle strength, elasticity, coordination, balance and endurance. • Improve the proprioception of joints. • Improve the overall physical condition through therapeutic exercise programs. • Suggest auxiliary agents to promote independence. • Adjustments that make the living space accessible and safe 5 . Physiotherapy Rehabilitation • Throughout the physiotherapy session, the patient should be placed correctly in bed for the correct execution of exercises. • The kinesiotherapy program: -starts with basic torso exercises -activities (strengthening of dorsal muscles, modified abdominal exercises where applicable, pelvic floor exercises). Marina Bucuku, Dimitris Nikolaou Given the unique characterization of the 'silent disease', osteoporosis stands as a chronic skeletal disorder, the principal trademark of which is the occurrence/manifestation of low-impact fractures. FRAX is an established diagnostic tool, which is used worldwide in order to evaluate the 10 year probability of bone fracture risk, regardless of the individual's gender. Being single out as easily accessible, FRAX is considered to be of substantial assistance for every clinical health-care practitioner. Due to the unavailability of a Greek calibrated version of the FRAX algorithm, the Greek clinical doctors, encountered noteworthy obstacles when it came to the precise assessment of the 10 year fracture risk 3, 4 . Greek epidemiologic data 5 . Nursing is a health profession which affects a wide range of agegroups, while being respectful to the associated health issue 6 . Beneficial yet constructive results can be achieved by the nursing stuff throughout the education of the individuals in the community. On the spotlight of these attempts, should be the individuals pictured as high-risk for the manifestation of osteoporosis. Since the identification of the high-fracture risk patient has been processed, the registered nurse being in consultation with the treating doctor, recommend as well assists the undergoing of a BMD scan. Lastly but not least, the nursing staff keeps an open eye for mistaken, misguided, irregular or abrupt disruption of the associated medication 7 . In favor of retaining a successful intervention, physical therapists are requested to deliberately construct a therapeutic plan focusing on physical activity. This particular plan should be designated as personalized for each individual, taking in consideration several distinctive aspects such as: • The maintenance of a lifestyle which encompasses physical activity • Adjustment of daily-living aspects or even habits which affect the loss of bone density • Preventing fall incidences that could induce low-energy factures • Strengthening, stretching and maintaining the required properties of musculature Musculoskeletal problems are highly associated with aging, and often lead to reduced functionality and frailty. The existing research background has highlighted the association of diet with osteoporosis, osteoarthritis and sarcopenia, as well as the effect of certain foods on inflammation and pain. The aim of this study was to correlate eating habits with the occurrence of musculoskeletal problems in elderly people. The study was carried out with Convenience sampling from November 2020 to January 2021 in 100 community-dwelling people over 65 years. 2 questionnaires were used: the Nordic Musculoskeletal Questionnaires (NMQs) and b) the Food Frequency Questionnaire (FFQ). The confidence interval and error rate were set at 95% and 5% respectively. 42% of the participants were women, and the mean age was 73.8 years. The areas with a higher musculoskeletal pain were the knees (55%), the low back (46%), the hips (46%) and the neck (41%). In addition, 44% had problems in everyday life due to pain at the knees, 35% at the low back, 32% at the hips and 34% at the shoulder blade during the last 12 months. A statistically significant negative correlation was found between the consumption of foods with antiinflammatory action (omega-3 fats, fiber and probiotics) and the existence of musculoskeletal problems [r(100)= -0.34, p=0.05]. A higher incidence of musculoskeletal problems was also found in men compared to women [t(98)=2.99, p<0.05]. The consumption of vegetables had a protective effect to musculoskeletal disorders, due to the high magnesium level. Finally, higher age was a significant risk factor of musculoskeletal disorders. The results of the present study showed that an unhealthy diet may be a cause for the occurrence of musculoskeletal disorders in older people. Nutritional interventions are of major importance in order to increase the adherence of older people in health eating habits. Interventions can focus on nutrition education, in addition to simply providing nutritional plans so that older people can choose food that can help reduce the chronic musculoskeletal pain. Epameinondas Evangelos Kantidakis, Ioannis Zachos, Kyriakos Pitsillos The COVID-19 pandemic has been and continues to be a challenging phenomenon for healthcare systems around the world, revealing several of their weaknesses. The implementation of lockdowns and quarantines was a key strategy to stop the spread of the pandemic, but without lack of consequences. The purpose of this study is to identify the factors that contributed to the occurrence of osteosarcopenia during the quarantine period, and to propose preventive measures. A literature search was conducted in PubMed using the following algorithm: ("sarcopenia" or "osteopenia" or "osteosarcopenia") and ("lockdown" or "containment" or "quarantine" or "pandemic" or "coronavirus" or "COVID*"). The publication date was set from 01/12/2019 to 31/03/2021. We found that factors such as reduced physical activity, sedentary lifestyle, unhealthy eating habits and reduced sun exposure, could predispose to osteosarcopenia. The impact of these factors is increased, when anxiety disorders, depression or lack of sleep are present. For prevention, a rehabilitative program, including aerobic, resistance, balance, coordination and mobility training exercises of 200 to 400 minutes, distributed among 5 to 7 days/week, is advised. A balanced diet with high-quality protein (meat, fish, dairy, eggs) also promotes muscle synthesis. The recommended protein intake amounts to 1.0 to 1.2 g/kg/day in healthy older adults. Measuring serum 25(OH)D levels and supplementing those whose levels are clearly below 10 ng/ml, with daily doses not exceeding 4000 IU should be a reasonably safe option. To summarize, lifestyle changes brought about by restrictive measures may lead to an increased incidence of osteosarcopenia, especially in the elderly. It is important to encourage people for adequate physical activity, healthy eating habits, and optimal regulation of comorbidities, so that possible new lockdowns or quarantines in the future could only have a positive contribution to the raging battle against COVID-19. program in reducing the fear of falls. A three-month intervention was conducted which included: • Personalized exercise program, according to the functionality and the risk of falling of the participants. The exercise book was based on Vivifrail program. • Weekly combined exercise and dance program, personalized diets and nutrition education. Both exercise and diet programs were self-evaluated by keeping a weekly diary. • Education on fall-related topics, based on the "Do not fall for it. Falls can be prevented!''. In order to enhance engagement, monthly projects were created in 3 thematic areas: personal risk factors, home safety, action plan in case of falling. Fear of falls was measured with the Falls Efficacy Scale -International (FES-I). 20 people (95% women, mean age 69 years) with a falls history or risk participated in the pilot implementation of this program. Fear of falls was reduced from the level of high anxiety (29<) to the level of moderate anxiety (values 20-27). Τhe mean FES-I value of the initial measurement was 29.9 (SD±10.36) and the respective value after the intervention was 26.31 (SD±9.29). Wilcoxon nonparametric control showed that there was a statistically significant difference between the two measurements (p<,05) which shows that the multilevel online intervention was effective. The evaluation of the diaries showed high compliance with the exercise program, while there was low compliance with the dietary guidelines. In conclusion, this pilot study showed that the program had positive results, as it reduced the fear of falls. In addition, the implementation of the program highlighted the need to educate older people in digital skills, the positive impact of online programs on emotional health and the concern for reliable ways of intervention that will lead to higher compliance with healthier nutritional habits. Ioannis Papaioannou, Georgia Pantazidou, Zinon Kokkalis, Neoklis Georgopoulos, Eleni Jelastopulu Current evidence supports that individuals with diabetes mellitus type 2 (T2DM) are more vulnerable to fragility fractures, although elderly patients with osteoporotic and especially hip fractures haven't receive the appropriate proportion of the publishing data. We retrospectively studied elderly patients (>60 years old) with low energy hip fractures, which were treated in our department during the last year between January 2020 and January 2021 to determine if T2DM consists a worth-noting risk factor for fragility hip fractures in this specific age group. Furthermore, we conducted a systematic review of the literature concerning elderly with fragility fractures (especially hip fractures) and the possible impact of T2DM. We retrieved 141 patients over 65 years old with fragility hip fractures from our department, 73 with extracapsular and 68 intracapsular, while mean age was 73.66. Among them we found 41 patients with T2DM, so a total 29,07% of the elderly with fragility hip fracture were also diabetic. This finding confirms the fact that diabetic elderly individuals are at increased risk for hip fractures. The results from our systematic review concludes that there is almost consensus about the increased prevalence of all kinds of fragility fractures and especially low-energy hip fractures among elderly patients with T2DM compared with their counterparts without T2DM, while there is relative controversy concerning the non-vertebral fractures. Insulin usage can even double the risk for fragility fracture. Bone fragility should be recognized as a new complication of T2DM, especially in elderly patients. The elderly patients are even more vulnerable to T2DM-induced bone fragility due to several additional aggravating factors, which include senile osteoporosis, severe vitamin D deficiency, presence of many comorbidities, increased possibility of insulin usage, presence of diabetes-related complications and especially diabetic neuropathy and retinopathy, predisposing to falls. Ioannis Papaioannou, Georgia Pantazidou, Zinon Kokkalis, Neoklis Georgopoulos, Eleni Jelastopulu The last two decades there has been expanding evidence describing the implications of vitamin D deficiency (VDD) in patients with type 2 diabetes mellitus (T2DM), although until now elderly haven't received the required proportion of the published studies. PubMed and Google Scholar were searched for relevant articles published up to October 2020. The keywords used were: VDD, elderly and diabetes mellitus type 2. Among 556 articles retrieved, 90 full texts were eligible and only 34 studies met the inclusion criteria for the review. According to this study there is adequate evidence to support the correlation between VDD and T2DM in elderly. Results from RCTs are more conflicting, so further studies are necessary to confirm the impact of VDD supplementation on metabolic, lipid profile, oxidative stress and complications of T2DM in elderly. VDD is clearly related with severe retinopathy, diabetic peripheral neuropathy and poor cognition performance, while there is consensus about the beneficial effect of vitamin D (VD) on peripheral artery disease, foot ulceration prevention and wound healing. There is controversy about the effect of VD supplementation on cardiovascular adverse events, endothelial function and estimated glomerular filtration rate (eGFR). The association of VDD with fragility fractures and depression in the elderly with T2DM is currently insufficiently studied and remains controversial. Undoubtedly, there is definite correlation of VDD with T2DM in elderly. The effect of VD supplementation on metabolic and lipid profile, oxidative stress and complications of T2DM in older patients require larger randomized controlled trials. Definition of the exact threshold of VD levels and the regimen of VD supplementation is important, although very difficult to be determined. Based on the small number of studies and the conflicting results in specific points of this topic, there is emerging need for new well-designed studies for elderly with T2DM and VDD. Assessment Tool. An exploratory assessment was conducted on the footwear of 3 older people, using the Footwear Assessment Tool. The measurements consist of six different subcategories, which determine the suitability of the shoe. The sample consisted of 3 pairs of shoes from each one of the 3 older people (9 in total). It was found that the ergonomic design of the home environment and the footwear constitutes an important issue in reducing the incidents of falls, as well as in the treatment and prevention of common foot disorders. According to the evaluation of the sample shoes with the Footwear Assessment Tool, 6 of them were less likely to cause a fall, whereas 3 of them had a higher chance to cause one, without any of them having entirely the most ideal or the least ideal features. To sum up, an important ergonomic factor in the prevention of falls is footwear. Defining the ideal shoe is not an easy task to achieve, as it has to combine several factors to be safe and appealing to wear. It is concluded that there is an urgency for further research, regarding the assessment of shoe factors and their association to falls. Percutaneous screw fixation for sacral insufficiency fractures: a review of three cases Fragility fractures of the pelvis: should they be fixed? The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Bisphosphonates and their influence on fracture healing: a systematic review Results of osteoporotic treatment drug after periarticular fracture of hip Does early administration of bisphosphonate affect fracture healing in patients with intertrochanteric fractures? Association between timing of zoledronic acid infusion and hip fracture healing Bisphosphonates and their influence on fracture healing: a systematic review Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly Economic costs of dysphagia among hospitalized patients Mini-mental state". A practical method for grading the cognitive state of patients for the clinician Validation of the Mini Nutritional Assessment Short-Form (MNA®-SF): A practical tool for identification of nutritional status The Hospital Anxiety and Depression Scale Adjunctive Functional Pharyngeal Electrical Stimulation Reverses Swallowing Disability After Brain Lesions Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2 A guide to improving the care of patients with fragility fractures, edition 2. Geriatric orthopaedic surgery & rehabilitation Dementia and fragility fractures: issues and solutions Clinical research in fragility fractures A multidisciplinary approach to improve the quality of care for patients with fragility fractures Shortterm outcome of fragility fractures of the pelvis in the elderly treated with References 1. Department of Health Hip fracture epidemiology in Greece during 1977-1992 Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment Chronic Musculoskeletal Pain and Nutrition: Where Are We and Where Are We Heading? Evidence-Based Role of Nutrients and Antioxidants for Chronic Pain Management in Musculoskeletal Frailty and Sarcopenia in Aging Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss Systematic rapid "living" review on rehabilitation needs due to COVID-19: update to March 31st, 2020 Sarcopenia: An underlying treatment target during the COVID-19 pandemic Vitamin D in COVID -19: Dousing the fire or averting the storm? -A perspective from the Asia-Pacific A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study Don't Fall For It-A guide to preventing falls for older people Vivifrail project resources Upper extremity bone mineral content asymmetries in tennis players: A systematic review and meta-analysis Effects of age and starting age upon side asymmetry in the arms of veteran tennis players: a cross-sectional study Bone mineral density of adolescent female tennis players and nontennis players Skin Blood Flow in the Forearms during Simulation of a Tennis Match: Implications for the Thermoregulatory Role of Dynamic Exercise Diabetes mellitus in elderly Epidemiology of fragility fractures Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation guidance Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis Diabetes mellitus in elderly Focus on vitamin D, inflammation and type 2 diabetes Vitamin D and chronic diseases The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis The associations between hypovitaminosis D, higher PTH levels with bone mineral densities, and risk of the 10-year probability of major osteoporotic fractures in Chinese patients with T2DM The epidemiology of falls and syncope A prospective study of the relationship between feared consequences of falling and avoidance of activity in communityliving older people Community exercise program for older adults recovering from hip fracture: a pilot study Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities Intensive physical training in geriatric patients after severe falls and hip surgery Development and evaluation of a tool for the assessment of footwear characteristics Barefoot vs common footwear: A systematic review of the kinematic, kinetic and muscle activity differences during walking Zacharoula Papadopoulou 1,2 , Prodromos Gazopoulos 2 , Ioannis Tsifountoudis 3 , Nikiforos Galanis The aim of this study was to evaluate the potential difference in bone mineral density (BMD) between the dominant and nondominant forearms of adult female handball players. Twelve adult female handball players (age mean 52 years) were recruited in order to measure the BMD of the dominant and non-dominant forearm and fifteen adult females (age mean 54 years) from the general population to serve as the control group. The dual-energy X-ray absorptiometry (DEXA) was utilized for this purpose. BMD was significantly higher in the dominant forearm of handball players (T-score: -1.1) compared to the non-dominant one (T-score: -1,8), (p<0.05). No significant differences were found in the control group.This study indicates that specific exercise could play a promising role in the prevention of osteoporosis. Fall-related fractures, especially in the elderly, have a negative impact on quality of life and are associated with disability and mortality risk 1 . Lack of self-confidence, and consequently, fear of falling (FoF) can lead to reduced physical function and social interaction 2 . The purpose of this review is to investigate whether physical activity can positively affect FoF experienced by the elderly after fragility fractures. PubMed was searched for studies assessing physical activity interventions in trials addressing people aged over 65 years. The aforementioned studies reported data on strength, balance, mobility and their impact on FoF. We included studies published until 2021 in English and conducted a qualitative synthesis of results. A total of 48 trials included. Most of the studies showed that physical activity improved balance and mobility, increased strength, and reduced the risk of falls in the elderly having experienced fragility fractures [3] [4] [5] . Physical activity, including balance training, strengthening exercises and flexibility, seems to be an effective intervention in improving balance control, reducing FoF and thus reducing falls in the elderly over 65 years of age.