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AAOS Now

Published 3/1/2007

News Updates: A Second Look

Stay current by subscribing to Headline News, the AAOS thrice-weekly online update of news of interest. Headline News brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS. Subscribe to Headline News at www.aaos.org/news.asp

JAMA articles examine long-term effects of drugs on bone health
A report on the Fracture Intervention Trial in the Journal of the American Medical Association (JAMA) (Vol. 296, No. 24, Dec 27, 2006) examines the long-term effects of alendronate on osteoporosis. “Effects of continuing or stopping alendronate after 5 years of treatment: The Fracture Intervention Trial Long-term Extension (FLEX): A randomized trial” reported that patients who took the osteoporosis drug alendronate for five years, then switched to placebo for five years, experienced declines in bone mineral density at the hip and spine. There was a significantly lower risk of clinically recognized vertebral fractures among those who continued the alendronate treatment.

The same issue also contained a report on “Long-term proton pump inhibitor therapy and risk of hip fracture.” The nested case control study found that long-term use of proton pump inhibitors (PPIs) may contribute to the risk of hip fracture. PPIs, which are commonly prescribed for heartburn, block calcium absorption. Based on the United Kingdom’s General Practice Research Data Base (1987-2003), researchers found that the adjusted odds ratio (AOR) for hip fracture associated with one year of PPI therapy was 1.22, and increased the longer the patient was on the drug (AOR of 1.41 after two years, 1.54 after three years and 1.59 after four years). More information on both studies can be found at: http://jama.ama-assn.org

Study supports plating clavicular fractures
A multicenter, randomized clinical trial, conducted by the Canadian Orthopaedic Trauma Society with support from the Orthopaedic Trauma Association and Zimmer, found that operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. The study randomized 132 patients with a displaced midshaft fracture of the clavicle to either operative treatment with plate fixation (67 patients) or nonoperative treatment with a sling (65 patients). Constant shoulder scores and Disability of the Arm, Shoulder and Hand scores were significantly improved in the operative fixation group at all time-points. The mean time to radiographic union was 28.4 weeks in the non-operative group compared with 16.4 weeks in the operative group. In addition, the operative group experienced only two nonunions and no symptomatic malunions, compared with seven nonunions and nine malunions in the nonoperative group. For more information, go to
http://www.ejbjs.org/

Are orthopedic residents getting enough training?
A study in the spring Journal of Surgical Orthopaedic Advances (Vol. 16, No. 1) examined “The Effect of Resident Work Hour Regulations on Orthopaedic Surgical Education.” The Accreditation Council for Graduate Medical Education (ACGME) changed work hour regulations for residents in July 2003. In a study evaluating the impact of these changes on surgical education at a two-person-per-year orthopaedic training program, data showed that PGY 2 and PGY 3 residents performed 21.5 percent fewer cases in 2003-2004 than in 2002-2003. The average number of cases per rotation decreased by 20.44 percent. Researchers hypothesized that residents trained under the new guidelines may have a lower skill level or that operative experience will shift to the senior resident years, prolonging the learning curve.

Vancomycin linked to sometimes-fatal bleeding condition
A study published in the New England Journal of Medicine (Vol. 356, No. 9, March 1, 2007) finds that the antibiotic vancomycin may be linked to severe bleeding in patients with thrombocytopenia. Data on 29 patients treated at various hospitals, all of whom tested positive for an antibody related to vancomycin, showed that three patients died of severe bleeding, and none experienced a rise in platelet counts until vancomycin was discontinued. Researchers recommend that physicians consult a hematologist if patients experience low platelet counts while taking vancomycin. The abstract of the study can be viewed at:
http://content.nejm.org

Study: Daily use of SSRI doubles risk of fractures
A study published in the Jan. 22 edition of Archives of Internal Medicine finds that daily use of selective serotonin reuptake inhibitors (SSRIs), a class of pharmaceuticals commonly prescribed for depression, may weaken bones and increase the risk of falling. Study participants who used SSRIs daily had an increased risk of fracture, increased odds of falling, and lower bone mineral density at the hip and spine. The abstract of the study can be viewed at:
http://tinyurl.com/2u9vrd

Older men, women have similar risk of second fracture
A study in JAMA (Vol. 297, No. 4, Jan. 24/31, 2007) examining the “Risk of subsequent fracture after low-trauma fracture in men and women” found that men and women have a similar risk of sustaining a second fracture after an initial low-trauma fracture. The prospective cohort study, conducted in Australia, followed 2,245 community-dwelling women and 1,760 men aged 60 years or older for 16 years (1989-2005). Among those with an initial fracture, the absolute refracture rate for women aged 60 to 69 years was 36/1000 person-years; for men of the same age, it was 37/1000 person-years. Multivariate analyses found that femoral neck bone mineral density, age, and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density, physical activity, and calcium intake were predictors in men. More information is available at:
http://jama.ama-assn.orgt