Many older patients with COVID-19 likely have co-morbid osteoporosis. We investigated the clinical outcomes of COVID-19 patients with osteoporosis. This was a retrospective cohort study using national claims data from Korea encoded in the common data model. Patients aged ≥ 50 years diagnosed with COVID-19 infection between January 2020 and April 2022 were included and stratified into two groups according to a history of osteoporosis. Clinical outcomes of COVID-19 infection were analyzed using logistic regression analysis after large-scale propensity score stratification. Of the 597,011 patients with COVID-19 included in the study, 105,172 had a history of osteoporosis. In patients with a history of osteoporosis, the odds of mortality decreased (odds ratio [OR] 0.82, P < 0.002), whereas most clinical outcomes of COVID-19 did not exhibit differences compared to those without such a history. Osteoporosis patients with a history of fractures showed increased odds of pneumonia, hospitalization, major adverse cardiac events, venous thromboembolism, and mortality, compared to patients without osteoporosis (ORs 1.34-1.58, P < 0.001 to P = 0.001). Our study suggests that patients with severe osteoporosis who have experienced fractures have an elevated risk of severe complications with COVID-19, while osteoporosis patients without fractures who have sought medical attention have a lower risk of mortality.

OBJECTIVE: Electric scooters (e-scooters) have become increasingly popular as a mode of transportation in recent years. The impact of e-scooter accidents on the healthcare system and resulting orthopaedic injuries remains largely unknown. This study describes the distribution of fractures caused by e-scooter accidents.
METHODS: All patients who had one or more fractures from e-scooter accidents registered in the Swedish Fracture Register (SFR) between 7 April 2019 and 30 December 2022 were included. Fractures were classified using the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. We analysed the distribution of fractures, the proportion that required surgical management and seasonal variation of injuries.
RESULTS: During the study period, 1,874 fractures in 1,716 patients were registered in the SFR. The mean age of patients was 29 (SD 14) years and 70% of fractures occurred in males. High-energy accidents accounted for 299 fractures (16%). The most common fractures were of the hand (n = 363, 19%), wrist (n = 352, 19%) and proximal forearm (n = 356, 19%). Wrist fractures were the most common injury in children (n = 183), accounting for 44% of paediatric fractures. Surgical treatment was performed on 556 (30%) fractures, with wrist fractures being the most commonly treated in both adults (n = 78, 17%) and children (n = 36, 36%).
CONCLUSIONS: Fractures caused by e-scooter accidents predominantly occur in the upper extremity. E-scooter accidents comprise a new source of injury requiring attention and surgical resources from an already strained healthcare system.

Whole-body vibration training (WBV) training has shown positive effects on bone strength, muscle strength, and balance, but the evidence on fall prevention is not yet persuasive. This study aimed to evaluate the effectiveness of WBV training in preventing falls and improving physical performance among older adults at fall risk. The study was an assessor- and participant-blinded, randomized, and controlled 10-week training trial with a 10-month follow-up. One hundred and thirty older adults (mean age 78.5 years, 75% women) were randomly allocated into the WBV group (n = 68) and the low-intensity wellness group (n = 62). Falls were prospectively collected using monthly returned and verified diaries. Physical performance was evaluated at baseline before randomization, after the intervention, and follow-up with established methods. The data were analyzed on an intention-to-treat basis. Negative binomial regression was used to estimate the incidence rate ratios for falls, and Cox regression models were used to calculate the hazard ratios for fallers. Between-group differences in physical performance were estimated by generalized linear mixed models. The retention rate was 93%, and the mean adherence to the WBV training was 88% and 86% to the wellness training. Sixty-eight participants fell at least once, and there were 156 falls in total. In the WBV group, the incidence rate of falls was 1.5 (95% confidence interval 0.9 to 2.5) compared to the wellness group (p = 0.11). The hazard ratio for fallers in the WBV group was 1.29 (0.78 to 2.15) (p = 0.32). There was no between-group difference in physical performance after the training period, but by the end of the follow-up, WBV-related benefits appeared. The chair-rising capacity was maintained in the WBV group, while the benefit disappeared in the wellness group (p = 0.004). Also, the 0.5-point difference in short physical performance battery (SPPB) score favored WBV training (p = 0.009). In conclusion, progressive side-alternating WBV training was feasible and well-tolerated among fall-prone older adults. During the one-year follow-up, WBV training was associated with improved physical performance but did not prevent falls compared to chair-based group exercises.

BACKGROUND: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).
METHODS: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.
RESULTS: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).
CONCLUSIONS: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

Lithium is considered to be the most effective mood stabilizer for bipolar disorder. Evolving evidence suggested lithium can also regulate bone metabolism which may reduce the risk of fractures. While there are concerns about fractures for antipsychotics and mood stabilizing antiepileptics, very little is known about the overall risk of fractures associated with specific treatments. This study aimed to compare the risk of fractures in patients with bipolar disorder prescribed lithium, antipsychotics or mood stabilizing antiepileptics (valproate, lamotrigine, carbamazepine). Among 40,697 patients with bipolar disorder from 1993 to 2019 identified from a primary care electronic health record database in the UK, 13,385 were new users of mood stabilizing agents (lithium:2339; non-lithium: 11,046). Lithium was associated with a lower risk of fractures compared with non-lithium treatments (HR 0.66, 95 % CI 0.44-0.98). The results were similar when comparing lithium with prolactin raising and sparing antipsychotics, and individual antiepileptics. Lithium use may lower fracture risk, a benefit that is particularly relevant for patients with serious mental illness who are more prone to falls due to their behaviors. Our findings could help inform better treatment decisions for bipolar disorder, and lithium\'s potential to prevent fractures should be considered for patients at high risk of fractures.

OBJECTIVE: To examine the risk of fractures in a cohort of patients with newly diagnosed rheumatoid arthritis (RA), compared to the background population, and predictors of fractures detectable early in RA.
METHODS: An inception cohort of patients with RA (N = 233; 164 women/69 men, recruited 1995-2005) was evaluated according to a structured program, including repeated clinical assessments and measures of bone mineral density (BMD), from diagnosis to 10 years later. Matched population controls were identified using the national census register. Fractures through 2019 were identified based on ICD codes. Cox regression models were used to assess the risk of fractures in RA patients compared with controls, and for assessment of potential predictors for fractures in the RA population.
RESULTS: RA patients had an increased risk of fractures (fully adjusted hazard ratio (HR) 1.52, 95 % CI 1.13; 2.06). In the RA cohort, high age, low body mass index, and low BMD were significant baseline predictors of future fractures in multivariate analyses, but baseline RA disease characteristics were not. Worse disability (i.e. higher Health Assessment Questionnaire (HAQ) scores) over time was significantly associated with increased risk of fractures (age-sex-adjusted HR 1.33 per SD, 95 % CI 1.09; 1.63) and there was an inverse association between BMD Z-scores over time and fractures.
CONCLUSIONS: Patients with RA had higher risk of fractures than controls. Fracture risk was related to BMD at baseline and over time in patients with RA. In addition, worse disability (measured by HAQ) over time was associated with higher risk of fractures.

The SPAH study is a population-based prospective cohort of Brazilian community-dwelling elderlies with higher fracture risk than observed in the studies used to construct the Brazilian FRAX model. In this study, the FRAX tool was a good fracture predictor within this high-risk elderly cohort, especially when calculated without bone density.
OBJECTIVE: To determine the performances of FRAX and age-dependent intervention thresholds according to National Osteoporosis Guideline Group (NOGG) guidelines with and without bone mineral density (BMD) regarding fracture prediction in community-dwelling elderly Brazilians.
METHODS: Seven hundred and five older adults (447 women; 258 men) were followed for 4.3 ± 0.8 years. FRAX risk for hip and major osteoporotic fractures with and without BMD was calculated at baseline. The bivariate analysis investigated the associations between the absolute probability of fracture (FRAX), as well as the age-dependent intervention thresholds (NOGG), and the incidence of vertebral fracture (VF), non-vertebral fracture (NVF), and major osteoporotic fractures (MOF), segregated by sex. Age-adjusted Poisson\'s multiple regression and ROC curves were constructed to determine FRAX and NOGG\'s accuracies as fracture predictors.
RESULTS: Fractures occurred in 22% of women and 15% of men. FRAX with and without BMD was higher in women with all types of fractures (p < 0.001). Only NOGG risk classification without BMD was associated with NVF (p = 0.047) and MOF (p = 0.024). FRAX was associated with NVF in the multiple regression, regardless of BMD. ROC curves of FRAX with and without BMD had AUCs of 0.74, 0.64, and 0.61 for NVF, VF, and MOF, respectively. The most accurate risk cutoffs for FRAX were 8% for MOF and 3% for hip fractures. No statistically significant associations were found in men.
CONCLUSIONS: FRAX predicted NVF more accurately than VF or MOF in elderlies, regardless of BMD. These results reiterate that FRAX may be used without BMD, even considering that Brazilian elderlies have known higher fracture risk.

UNASSIGNED: To determine the prevalence of maxillofacial fractures associated with persistent CSF leak, and to assess its bearing on clinical outcomes of consecutive patients managed at our centre.
UNASSIGNED: This was a retrospective cross-sectional study. The medical records of patients over 11-year period were analysed for age, gender, etiology of injuries, duration between injury and presentation to the hospital, types of facial fracture and their treatments, treatment done to control CSF leak, and complication(s). Descriptive and bivariate statistics were computed.
UNASSIGNED: Overall, 1473 patients were evaluated, 66 (4.5%) presented with craniofacial injuries associated with persistent CSF leak after 5 days of non-surgical treatment. Males (92.5%, P= 0.0000) and those in the 21 to 30 years age group (59.1 %, P=0.01) were predominant. The most common (68.2%) type of fracture combination was Le Fort I, II and III, NOE, zygomatic complex and mandible. The commonest clinical presentation of CSF leak was rhinorrhea only, in 66.7% of patients (P= 0.001).
UNASSIGNED: This study shows that the prevalence of maxillofacial fractures associated with persistent CSF leak was low, which was 4.5% of patients that presented with persistent CSF leak and 84.9% of the cases resolved after treatment of the various maxillofacial fractures.

UNASSIGNED: Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) and fracture is unknown. We examined whether incident fall injuries, including NFFI and fractures, were associated with higher Medicare spending in 12 months after incident events in older adults.
UNASSIGNED: The Health, Aging, and Body Composition Study included 1 595 community-dwelling adults (53% women, 37% Black; 76.7 ± 2.9 years) with linked Medicare Fee-For-Service (FFS) claims at 2000/01 exam. Incident outpatient and inpatient fall injuries (N = 448) from 2000/01 exam to December 31, 2008 were identified using the first claim with a nonfracture injury diagnosis code with a fall E-code, or a fracture diagnosis code with/without an E-code. Up to 3 participants without fall injuries (N = 1 147) were matched on nonfall events to 448 participants in the fall injury month. We calculated the change in monthly FFS spending in 12 months before versus after index events in both groups. Generalized linear regression with centered outcomes and gamma distributions examined the association of prepost expenditure changes with fall injuries (including NFFI and fractures) adjusting for related covariates.
UNASSIGNED: Monthly spending increased after versus before fall injuries (USD$2 261 vs $981), nonfracture (N = 105; USD$2 083 vs $1 277), and fracture (N = 343; USD$2 315 vs $890) injuries (all p < .0001). However, after adjusting for covariates in final models, fall injuries were not significantly associated with larger increases in spending/month versus nonfall events (differential increase: USD$399.58 [95% CI: -USD$44.95 to $844.11]). Fracture prepost change in monthly spending was similar versus NFFI (differential increase: USD$471.93 [95% CI: -USD$21.17 to $965.02]).
UNASSIGNED: Although substantial increases occurred after injuries, with fracture and NFFI increasing similarly, changes in monthly spending after fall injury were not different compared to nonfall events. Our results contribute to the understanding of subsequent spending after fall injury that may inform further research on fall injury-related health care spending.

Unconventional reservoirs, such as shale and tight formations, have become increasingly vital contributors to oil and gas production. In these reservoirs, fractures serve as crucial spaces for fluid migration and storage, making their precise assessment essential. Array acoustic logging stands out as a pivotal method for evaluating fractures. To investigate the impact of fracture width, fracture-filling conditions, and acoustic frequency on compressional and shear waves, a three-dimensional variable mesh finite difference program was employed for acoustic logging numerical simulation. Firstly, numerical models representing fractured formations with varying fracture widths and distinct fluid-filling conditions were established, and array acoustic logging numerical simulations were conducted at different frequencies. Subsequently, the waveform data were processed to extract acoustic characteristic parameters, such as velocities and amplitude attenuations of compressional and shear waves. Finally, a quantitative analysis was conducted to examine the variation patterns of characteristic parameters of refracted compressional and shear waves in relation to fracture properties. The research results indicate that amplitude attenuation information derived from borehole wave modes is particularly sensitive to the changes in fracture properties. As fracture width increased, we observed a significant amplitude attenuation in both compressional and shear waves, proportional to the logarithm of the attenuation coefficients. Furthermore, when the fracture width was constant, gas-filled fractures exhibited more prominent amplitude attenuation than water-filled fractures, with shear wave attenuation being more sensitive to the filling material. Moreover, from a quantitative perspective, the analysis revealed that the attenuation coefficients of refracted compressional and shear waves exhibited an exponential variation with gas saturation. Notably, once fracture width and filling conditions were established, the amplitudes of compressional and shear waves at the dominant frequency of 40 kHz were significantly reduced compared to those at 8 kHz, accompanied by increased attenuation. Subsequent quantitative analysis revealed that, when the product of fracture width and dominant frequency remains constant, the corresponding attenuation coefficient ratios approach 1. This indicates that the attenuation process of acoustic propagation in fractured media follows the principle of acoustic similarity. The findings of this study provide reference for further research on fracture property evaluation methods based on array acoustic logging data.