Using vital statistics to estimate the population-level impact of osteoporotic fractures on mortality based on death certificates, with an application to France (2000-2004)

Abstract Background We developed a methodology using vital statistics to estimate the impact of osteoporotic fractures on the mortality of an entire population, and applied it to France for the period 2000-2004. Methods Current definitions of osteoporotic fractures were reviewed and their components identified. We used the International Classification of Diseases with national vital statistics data for the French adult population and performed cross-classifications between various components: age, sex, I-code (site) and E-code (mechanism of fracture). This methodology allowed identification of appropriate thresholds and categorization for each pertinent component. Results 2,625,743 death certificates were analyzed, 2.2% of which carried a mention of fracture. Hip fractures represented 55% of all deaths from fracture. Both sexes showed a similar pattern of mortality rates for all fracture sites, the rate increased with age from the age of 70 years. The E-high-energy code (present in 12% of death certificates with fractures) was found to be useful to rule-out non-osteoporotic fractures, and to correct the overestimation of mortality rates. Using this methodology, the crude number of deaths associated with fractures was estimated to be 57,753 and the number associated with osteoporotic fractures 46,849 (1.85% and 1.78% of all deaths, respectively). Conclusion Osteoporotic fractures have a significant impact on overall population mortality.</p

Microvascular bone grafting: A new long-term solution for intraosseous arteriovenous malformations of the mandible in children

BACKGROUND: Intraosseous arteriovenous malformations (AVMs) in the maxillofacial area are rarely reported in the current literature. These malformations have been associated with severe hemorrhage resulting in significant morbidity and mortality. The recommended gold standard treatment of AVMs is an endovascular embolization, combined with surgery. Especially in children, disease management remains a challenge for the surgeon due to the process of bone growth. AIM: In this report, we describe our experience with a microvascular bone graft as another possible surgical technique for the treatment of intraosseous AVMs in children. PATIENT AND METHODS: A 15-year-old boy was admitted to our department with a life-threatening hemorrhage due to an AVM of the left mandible. The attempt of an ordinary tooth extraction had lead to the emergency. Several embolizations and surgical interventions were required. Finally, a bony reconstruction with a microvascular bone graft from the right iliac crest was performed in order to achieve a normal form and function of the mandible. Postoperative recovery of the patient was unremarkable, and no recurrence was reported. Dental rehabilitation and a good esthetic outcome were achieved by insertion of dental implants. RESULTS: The performed interventions resulted in a complete anatomic and clinical cure. CONCLUSION: We suggest microvascular bone grafts from the anterior iliac crest as a valuable alternative in the long-term treatment of intraosseous AVMs, especially for extensive defects and in children