ПОКАЗНИКИ 12-МІСЯЧНОЇ ЛЕТАЛЬНОСТІ У ХВОРИХ З ПЕРЕЛОМОМ ПРОКСИМАЛЬНОГО ВІДДІЛУ СТЕГНОВОЇ КІСТКИ

Introduction. Hip fractures (HF) are an important medical and social problem with a significant financial burden for different countries, but data about mortality and survival rates after these fractures vary from country to country and are limited in Ukraine. The aim was to study the indices of 12-month mortality and survival in patients of older age groups after HF. Materials and methods. In the retrospective study, we analyzed these indices in 350 people aged 50 years and older with an HF. The analysis was performed in the general group, depending on age and sex, fracture location, and treatment tactics. The mortality rate was calculated according to a standard formula. The survival rate was assessed using Kaplan-Meier analysis and Cox's F-test. Results. The indices of 6-month mortality in patients with HF was 10.0 %, 12-month mortality – 12.9 %. Survival rate was higher in patients with timely hospitalization and surgery and did not differ depending on fracture localization. 6-month mortality after HF did not differ depending on sex against the background of slightly higher indices of 12-month mortality in men (14.4 %) compared with the corresponding indices in women (12.1 %). All the above confirms the need for timely tactics of surgical treatment of patients to save their lives and health.Вступ. Переломи проксимального відділу стегнової кістки (ПВСК) є важливою медико-соціальною проблемою з вагомим фінансовим тягарем, проте дані щодо показників летальності та виживаності хворих після перелому відрізняються у різних країнах, а в Україні обмежені. Мета – вивчити показники 12-міс. летальності та виживаності у хворих старших вікових груп після перелому ПВСК. Матеріали й методи. У ретроспективному дослідженні проаналізовано вищезазначені показники у 350 осіб віком 50 років і старше з переломом ПВСК за 12 міс. Аналіз проводили в загальній групі, залежно від віку й статі, локалізації перелому й тактики лікування. Показники летальності розраховували згідно до стандартної формули. Показники виживаності оцінювали з використанням аналізу Kaplan-Meier та Cox's F-тесту. Результати. Показники 6-міс. летальності у хворих після перелому ПВСК складають 10,0 %, 12-міс. летальності – 12,9 %. Показники виживаності у хворих з переломом даної локалізації вищі при своєчасній госпіталізації та проведенні оперативного втручання й не відрізняються залежно від виду перелому. Показники летальності через 6-міс. після перелому ПВСК не відрізняються залежно від статі на тлі дещо вищих показників летальності через 12-міс. після перелому ПВСК у чоловіків (14,4 %) порівняно з відповідними показниками в жінок (12,1 %). Усе вищезазначене підтверджує необхідність своєчасної тактики оперативного лікування хворих з ППВСК для збереження їх життя та здоров’я

Epidemiology of hip fracture and the development of FRAX in Ukraine

Summary A country-specific FRAX model has been developed for the Ukraine to replace the Austrian model hitherto used. Comparison of the Austrian and Ukrainian models indicated that the former markedly overestimated fracture probability whilst correctly stratifying risk. Introduction FRAX has been used to estimate osteoporotic fracture risk since 2009. Rather than using a surrogate model, the Austrian version of FRAX was adopted for clinical practice. Since then, data have become available on hip fracture incidence in the Ukraine. Methods The incidence of hip fracture was computed from three regional estimates and used to construct a country-specific FRAX model for the Ukraine. The model characteristics were compared with those of the Austrian FRAX model, previously used in Ukraine by using all combinations of six risk factors and eight values of BMD (total number of combinations =512). Results The relationship between the probabilities of a major fracture derived from the two versions of FRAX indicated a close correlation between the two estimates (r > 0.95). The Ukrainian version, however, gave markedly lower probabilities than the Austrian model at all ages. For a major osteoporotic fracture, the median probability was lower by 25% at age 50 years and the difference increased with age. At the age of 60, 70 and 80 years, the median value was lower by 30, 53 and 65%, respectively. Similar findings were observed for men and for hip fracture. Conclusion The Ukrainian FRAX model should enhance accuracy of determining fracture probability among the Ukrainian population and help to guide decisions about treatment. The study also indicates that the use of surrogate FRAX models or models from other countries, whilst correctly stratifying risk, may markedly over or underestimate the absolute fracture probability

Guideline for diagnostic, prevention and treatment of postmenopausal osteoporosis

Background.Postmenopausal osteoporosis (PMO), which is developed due the estrogen deficiency in women after menopause, is the most common type of systemic osteoporosis. The latest Ukrainian recommendation for its management requires revision due to new data from high-quality research performed in recent years. Thepurposewas to develop a guideline on the diagnosis, prevention, and treatment of PMO based on an analytical analysis of modern literary sources in order to improve the awareness of the medical community of Ukraine. Methodology. To develop the guideline, an expert group of 13 leading Ukrainian scientists of various specialties was created who conducted a thorough review of modern literature on this topic, assessed the level of existing evidence using the GRADE system, proposed and voted on 15 recommendations of the guideline. Results. The guideline contains chapters on diagnosis and differential diagnosis of PMO, assessment of the osteoporotic fracture risk, the role of bone turnover markers in the management of PMO, and modern strategies of antiosteoporotic treatment.Conclusions. The Ukrainian guideline on the diagnosis, prevention, and treatment of PMO, which contains 15 main recommendations, created on the basis of a thorough analysis and synthesis of modern literature data, is an important tool for the management of PMO and is recommended by Ukrainian Association of Osteoporosis for use in Ukrainian medical community

Epidemiology of hip fractures in two regions of Ukraine

Worldwide, the number of hip fractures, the most important osteoporotic complication in the elderly, continues to increase in line with the ageing of the population. In some countries, however, including the Ukraine, data on the incidence of hip fracture are limited. This article describes the first analysis to characterize the incidence of hip fracture in the Ukrainian population from the age of 40 years. It is based on data from two regional studies, namely, the Vinnitsa city study and the STOP study, which were performed during 1997-2002 and 2011-2012 years, respectively. Hip fracture incidence rates were demonstrated to increase with increasing age. The rates were higher among younger men than women, however, with a female preponderance from the age of 65 years upwards. The incidence of hip fractures in Ukraine is 255.5 per 100,000 for women aged 50 years and older and 197.8 per 100,000 for men of the corresponding age. Overall, the incidence of hip fracture was comparable with data from neighboring countries, such as Poland and Romania. Hip fractures constitute a serious healthcare problem in Ukraine, and changes in healthcare are required to improve the management and long-term care of osteoporosis and its complications

Letter of Editor-in-Chief

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10-year probability of major osteoporotic fractures and hip fractures according to Ukrainian model of FRAX® in women with vertebral fractures

Background. Vertebral fractures are one of the severe complications of systemic osteoporosis, which lead to the low-back pain, decrease or loss of efficiency and increase of mortality in older people. FRAX and dual-energy X-ray absorptiometry (DXA) are important methods in determining major osteoporotic fractures risk, including vertebral fractures. Materials and methods. We studied the parameters of Ukrainian model of FRAX in women depending on the presence of vertebral fractures. 652 patients aged 40–89 years examined at the Ukrainian Scientific Medical Center of Osteoporosis were divided into two groups: the first one — 523 women without any previous fractures, the second one — 129 patients with previous vertebral fractures. The assessment of bone mineral density (BMD) was performed using DXA (Prodigy, General Electric). The 10-year probability of major osteoporotic fractures (FRAX-MOF) and hip fractures (FRAX-HF) has been determined using Ukrainian model of FRAX according to two methods — with body mass index (FRAXBMI) and BMD. Results. According the distribution of FRAXBMI-MOF parameters in women depending on the presence of vertebral fractures, it was found that index of FRAXBMI-MOF was less than 20 % (the limit indicated as the criterion for treatment initiation in US guidelines) in 100 and 100 % of subjects, respectively. The indices of FRAX BMD-HF were less than 3 % (the limit for starting treatment in US guidelines) in 95 and 55 % of women, respectively. It was shown the significant moderate correlation between the indices of two methods in all groups for both parameters of the algorithm — FRAX-MOF and FRAX-HF. Conclusions. The study of the age-specific features of FRAX in women depending on the presence of vertebral fractures showed a significant increase in the risks for both major osteoporotic and hip fractures, regardless of the used technique (with BMI or BMD) in women with vertebral fractures or without any fractures. Our results should be taken into account when assessing the risk of osteoporotic fractures in postmenopausal women and planning treatment and prophylactic measures