Postpartum osteoporosis associated with proximal tibial stress fracture

A 33-year-old woman presented with acute nonspecific knee pain, 6months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fractur

Reference values and clinical predictors of bone strength for HR-pQCT-based distal radius and tibia strength assessments in women and men.

Reference values for radius and tibia strength using multiple-stack high-resolution peripheral quantitative computed tomography (HR-pQCT) with homogenized finite element analysis are presented in order to derive critical values improving risk prediction models of osteoporosis. Gender and femoral neck areal bone mineral density (aBMD) were independent predictors of bone strength. INTRODUCTION The purpose was to obtain reference values for radius and tibia bone strength computed by using the homogenized finite element analysis (hFE) using multiple stacks with a HR-pQCT. METHODS Male and female healthy participants aged 20-39 years were recruited at the University Hospital of Bern. They underwent interview and clinical examination including hand grip, gait speed and DXA of the hip. The nondominant forearm and tibia were scanned with a double and a triple-stack protocol, respectively, using HR-pQCT (XCT II, SCANCO Medical AG). Bone strength was estimated by using the hFE analysis, and reference values were calculated using quantile regression. Multivariable analyses were performed to identify clinical predictors of bone strength. RESULTS Overall, 46 women and 41 men were recruited with mean ages of 25.1 (sd 5.0) and 26.2 (sd 5.2) years. Sex-specific reference values for bone strength were established. Men had significantly higher strength for radius (mean (sd) 6640 (1800) N vs. 4110 (1200) N; p < 0.001) and tibia (18,200 (4220) N vs. 11,970 (3150) N; p < 0.001) than women. In the two multivariable regression models with and without total hip aBMD, the addition of neck hip aBMD significantly improved the model (p < 0.001). No clinical predictors of bone strength other than gender and aBMD were identified. CONCLUSION Reference values for radius and tibia strength using multiple HR-pQCT stacks with hFE analysis are presented and provide the basis to help refining accurate risk prediction models. Femoral neck aBMD and gender were significant predictors of bone strength

Tibial or hip BMD predict clinical fracture risk equally well: results from a prospective study in 700 elderly Swiss women

Summary: In a randomly selected cohort of Swiss community-dwelling elderly women prospectively followed up for 2.8 ± 0.6years, clinical fractures were assessed twice yearly. Bone mineral density (BMD) measured at tibial diaphysis (T-DIA) and tibial epiphysis (T-EPI) using dual-energy X-ray absorptiometry (DXA) was shown to be a valid alternative to lumbar spine or hip BMD in predicting fractures. Introduction: A study was carried out to determine whether BMD measurement at the distal tibia sites of T-EPI and T-DIA is predictive of clinical fracture risk. Methods: In a predefined representative cohort of Swiss community-dwelling elderly women aged 70-80years included in the prospective, multi-centre Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture risk (SEMOF) study, fracture risk profile was assessed and BMD measured at the lumbar spine (LS), hip (HIP) and tibia (T-DIA and T-EPI) using DXA. Thereafter, clinical fractures were reported in a bi-yearly questionnaire. Results: During 1,786 women-years of follow-up, 68 clinical fragility fractures occurred in 61 women. Older age and previous fracture were identified as risk factors for the present fractures. A decrease of 1 standard deviation in BMD values yielded a 1.5-fold (HIP) to 1.8-fold (T-EPI) significant increase in clinical fragility fracture hazard ratio (adjusted for age and previous fracture). All measured sites had comparable performance for fracture prediction (area under the curve range from 0.63 [LS] to 0.68 [T-EPI]). Conclusion: Fracture risk prediction with BMD measurements at T-DIA and T-EPI is a valid alternative to BMD measurements at LS or HIP for patients in whom these sites cannot be accessed for clinical, technical or practical reason

Low mass binary neutron star mergers : gravitational waves and neutrino emission

Neutron star mergers are among the most promising sources of gravitational waves for advanced ground-based detectors. These mergers are also expected to power bright electromagnetic signals, in the form of short gamma-ray bursts, infrared/optical transients, and radio emission. Simulations of these mergers with fully general relativistic codes are critical to understand the merger and post-merger gravitational wave signals and their neutrinos and electromagnetic counterparts. In this paper, we employ the SpEC code to simulate the merger of low-mass neutron star binaries (two $1.2M_\odot$ neutron stars) for a set of three nuclear-theory based, finite temperature equations of state. We show that the frequency peaks of the post-merger gravitational wave signal are in good agreement with predictions obtained from simulations using a simpler treatment of gravity. We find, however, that only the fundamental mode of the remnant is excited for long periods of time: emission at the secondary peaks is damped on a millisecond timescale in the simulated binaries. For such low-mass systems, the remnant is a massive neutron star which, depending on the equation of state, is either permanently stable or long-lived. We observe strong excitations of l=2, m=2 modes, both in the massive neutron star and in the form of hot, shocked tidal arms in the surrounding accretion torus. We estimate the neutrino emission of the remnant using a neutrino leakage scheme and, in one case, compare these results with a gray two-moment neutrino transport scheme. We confirm the complex geometry of the neutrino emission, also observed in previous simulations with neutrino leakage, and show explicitly the presence of important differences in the neutrino luminosity, disk composition, and outflow properties between the neutrino leakage and transport schemes.Comment: Accepted by PRD; 23 pages; 24 figures; 4 table

Comparative trends in hospitalizations for osteoporotic fractures and other frequent diseases between 2000 and 2008

Summary: In Switzerland, the number, incidence, and cost of acute hospitalizations for major osteoporotic fractures (MOF) and major cardiovascular events (MCE) increased in both women and men between 2000 and 2008, although the mean length of stay (LOS) was significantly reduced. Similar trend patterns were observed for hip fractures and strokes (decrease) and nonhip fractures and acute myocardial infarctions (increase). Introduction: The purpose of this study was to compare the trends and epidemiological characteristics of hospitalizations for MOF and other frequent diseases between years2000 and 2008 in Switzerland. Methods: Trends in the number, age-standardized incidence, mean LOS, and cost of hospitalized MOF and MCE (acute myocardial infarction, stroke, and heart failure) were compared in women and men aged ≥45years, based on data from the Swiss Federal Statistical Office. Results: Between 2000 and 2008, the incidence of acute hospitalizations for MOF increased by 3.4% in women and 0.3% in men. In both sexes, a significant decrease in hip fractures (−15.0% and −11.0%) was compensated by a concomitant, significant increase in nonhip fractures (+24.8% and +13.8%). Similarly, the incidence of acute hospitalizations for MCE increased by 4.4% in women and 8.2% in men, as an aggregated result from significantly increasing acute myocardial infarctions and significantly decreasing strokes. While the mean LOS in the acute inpatient setting decreased almost linearly between years2000 and 2008 in all indications, the inpatient costs increased significantly (p < 0.001) for MOF (+30.1% and +42.7%) and MCE (+22.6% and +47.1%) in women and men, respectively. Conclusions: Between years2000 and 2008, the burden of hospitalized osteoporotic fractures to the Swiss healthcare system has continued to increase in both sexes. In women, this burden was significantly higher than that of MCE and the gap widened over tim

Fracture hospitalizations between years 2000 and 2007 in Switzerland: a trend analysis

Summary: In Switzerland, the total number and incidence of hospitalizations for major osteoporotic fractures increased between years 2000 and 2007, while hospitalizations due to hip fracture decreased. The cost impact of shorter hospital stays was offset by the increasing cost per day of hospitalization. Introduction: The aim of the study was to establish the trends and epidemiological characteristics of hospitalizations for major osteoporotic fractures (MOF) between years 2000 and 2007 in Switzerland. Methods: Sex- and age-specific trends in the number and crude and age-standardized incidences of hospitalized MOF (hip, clinical spine, distal radius, and proximal humerus) in women and men aged ≥45years were analyzed, together with the number of hospital days and cost of hospitalization, based on data from the Swiss Federal Statistical Office hospital database and population statistics. Results: Between 2000 and 2007, the absolute number of hospitalizations for MOF increased by 15.9% in women and 20.0% in men, mainly due to an increased number of non-hip fractures (+37.7% in women and +39.7% in men). Hospitalizations for hip fractures were comparatively stable (−1.8% in women and +3.3% in men). In a rapidly aging population, in which the number of individuals aged ≥45years grew by 11.1% (women) and 14.6% (men) over the study period, the crude and age-standardized incidences of hospitalizations decreased for hip fractures and increased for non-hip MOF, both in women and men. The length of hospital stay decreased for all MOF in women and men, the cost impact of which was offset by an increase in the daily costs of hospitalization. Conclusions: Between years 2000 and 2007, hospitalizations for MOF continued to increase in Switzerland, driven by an increasing number and incidence of hospitalizations for non-hip fractures, although the incidence of hip fractures has decline

Neutrino-heated winds from millisecond protomagnetars as sources of the weak r-process

We explore heavy element nucleosynthesis in neutrino-driven winds from rapidly rotating, stronglymagnetized protoneutron stars (‘millisecond protomagnetars’) forwhich themagnetic dipole is aligned with the rotation axis, and the field is assumed to be a static force-free configuration. We process the protomagnetar wind trajectories calculated by Vlasov, Metzger & Thompson through the r-process nuclear reaction network SkyNet using contemporary models for the evolution of the wind electron fraction during the protoneutron star cooling phase. Although we do not find a successful second or third-peak r-process for any rotation period P, we show that protomagnetars with P ∼ 1–5 ms produce heavy element abundance distributions that extend to higher nuclear mass number than from otherwise equivalent spherical winds (with the mass fractions of some elements enhanced by factors of �100–1000). The heaviest elements are synthesized by outflows emerging along flux tubes that graze the closed zone and pass near the equatorial plane outside the light cylinder. Due to dependence of the nucleosynthesis pattern on the magnetic field strength and rotation rate of the protoneutron star, natural variations in these quantities between core collapse events could contribute to the observed diversity of the abundances of weak r-process nuclei in metal-poor stars. Further diversity, including possibly even a successful third-peak r-process, could be achieved for misaligned rotators with non-zero magnetic inclination with respect to the rotation axis. If protomagnetars are central engines for GRBs, their relativistic jets should contain a high-mass fraction of heavy nuclei of characteristic mass number ¯A ≈ 100, providing a possible source for ultrahigh energy cosmic rays comprised of heavy nuclei with an energy spectrum that extends beyond the nominal Grezin–Zatsepin–Kuzmin cut-off for protons or iron nuclei

SpECTRE: A Task-based Discontinuous Galerkin Code for Relativistic Astrophysics

We introduce a new relativistic astrophysics code, SpECTRE, that combines a discontinuous Galerkin method with a task-based parallelism model. SpECTRE's goal is to achieve more accurate solutions for challenging relativistic astrophysics problems such as core-collapse supernovae and binary neutron star mergers. The robustness of the discontinuous Galerkin method allows for the use of high-resolution shock capturing methods in regions where (relativistic) shocks are found, while exploiting high-order accuracy in smooth regions. A task-based parallelism model allows efficient use of the largest supercomputers for problems with a heterogeneous workload over disparate spatial and temporal scales. We argue that the locality and algorithmic structure of discontinuous Galerkin methods will exhibit good scalability within a task-based parallelism framework. We demonstrate the code on a wide variety of challenging benchmark problems in (non)-relativistic (magneto)-hydrodynamics. We demonstrate the code's scalability including its strong scaling on the NCSA Blue Waters supercomputer up to the machine's full capacity of 22,380 nodes using 671,400 threads.Comment: 41 pages, 13 figures, and 7 tables. Ancillary data contains simulation input file

From the microscopic to the macroscopic world: from nucleons to neutron stars

Recent observations of neutron-star properties, in particular the recent detection of gravitational waves emitted from binary neutron stars, GW 170817, open the way to put strong constraints on nuclear interactions. In this paper, we review the state of the art in calculating the equation of state of strongly interacting matter from first principle calculations starting from microscopic interactions among nucleons. We then review selected properties of neutron stars that can be directly compared with present and future observations.Comment: 28 pages, 9 figures, Special Issue Article for Journal of Physics