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Functional outcome in elderly hip fracture patients treated in a rehabilitation hospital
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FUNCTIONALOUTCOW IN ELDERLY HIP FRACTURE PATIENTS TREATED IN A REHABILITATION HOSPITAL. D. Slovik. P. Spaulding Rehabilitation Hospital and Mnassian. nassachusetcs General Hospital, Boston, HA 02114, USA. Hip fractures are the major disabling injuries in In the United States more then elderly osteoporotics. 250,000 hip fractures occur annually at a cost This doesn’t include the cost approaching $10 billion. for long-term care or the personal suffering, morbidity, and mortality associated vith them. At this time, it is controversial as to the best way to rehabilitate this group and get them to their highest functional level. One way is to admit them to a rehabilitation facility. The Spaulding Rehabilitation Hospital (SRH) is a 284 bed rehabilitation hospital caring far patients vith Parients admitted to SRH many different disabilities. must meet the acute hospiral rehabilitation level of indicating they have associated fare auidelines signifiiant medical problems: Last year there were 377 The aatienls admitred to the majar fracture progeam. mean length of stay for this program was 31 t 2 days A subset of 48 were evaluated on (mean * SD). admission, at discharge, and at a 3-month follow up. the using The functional outcome was assessed This has 7 scoees standardized Uniform Dais Set. ranging from complete independence to total assistance. Outcome data shows that following a rehabilitation flmbulate patients the 90x of hosnitalization, iadipendently; ?lX dress lndependentiy, 64% are capable of meal Dreparat ion and light home management,and 60% can negaiiak stairs indep&dently. Pour percent of the patients were discharged to a rate of 4X is nursing home. The long-term institutional signifieanrly less than the 20-30X level documented in Data such as ours supports the idea the literature. tuat a short rehabilitation stay minimizes long-term resource utilization and improves function.
341 A STUDY OF THEEFFECT OF EEL CALCI'IDNIN (EUYVIONIN) ON MNE FAIN INOSI'EOWROSIS. RAJANK T & EVANB W D. RHEUMATISM RESEARCH CENPRE, LWWYPRIDD a DISTRICl’HOSPITAL, FQWYPRIDD, CF374AL & LJh'IVERSITY HOSPITALOF P&ES, CARDIFFCF44XWS WALES. Eone pain is the min clinical symptan in patients with osteoporosis. Even though there may be advantages in using eel Calcitonin, i.e. nasal route of administration smaller dose and greater stability, it is not known whether it is as effective as parenteraly adminiStered salmon Calcitonin in reducing bone pain. This prospective study was carried out over six months in ten post menopausal osteoporotic females (meanage 64 years - range-59 -72) with bone pain due to vertebral fracture. All received eel Calcitoninas a nasal spray (4OIU for each nostril on rising from bzd each day). Bone mineral content was determined using Holcgic Dsnsitaneter prior to starting treatment and again at six months. Spontaneous pain was measured using a visual analcgue scale, 0= no pain & 10= severe pain. ‘WI hour urine hydroxyproline/ creatinine ratios and calcium excretion were also measured before 8 after completing six months treatment. til eel Calcitonin treated patients had significant pain relief, the pain score falling ~XXII7.8521.16 before treatment to 1.2+_2.04 after treatment.. Pain relief began within ten days and continued throughout the duration of therapy. In one individual treatment had to be supplemented by HRTbefore the reduction in hone pain could be sustained. There was no significant change in the bone mass following six months treatment with eel Calcitonin,pretreatment (mean+_sd)0.62620. 14 post-treatment 0.6320.14. No significant change in the biochemical parameters was observed. This study confirms the rapid and sustained analgesic effect of nasal Calcitonin in relieving the bone pain associated with osteoporotic vertebral fracture.
3r12 OSTEOPOROSIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): OSTEOCALCIN AND TOTAL ALKALINE PHOSPl-‘9TASE REFLECT REDUCED BONE DENSITY DURING LONG-TERM TREATMENT WITH PREDNISOLONE. It
343 SEX SPECIFIC RESPONSIVENESS OF RAT BONE TO SEX STEROIDS: MODULATION BY GONADECTOMY AND GONADAL , Endocrine Unit, lchilov STEROIDS. Hospital, Tel Aviv and ‘3eparlment of Hormone Research, The Weizmann Institute of Science, Rehovot, Israel. We have shown previously that gonadal steroids, such as 17ptestosterone (T) and dihydrotesterone (DHT) can estradlol @a). slimulale creatine kinase (CK) specific aclivily in rat diaphyseal bone In a sex speciffo manner; immalure female rats respond only to E2, whereas Immature males respond exclusively to T or DHT. Here we report the effects of Es and DHT on gonadeclomized rats, a model for poslmenopausal osteoporosis. In either ovariectomlzed or castrated rats, dlaphyseal bone lost Its sex specific response by 7 days after surgery, i.e. bones from either gonadectomized male or female rats responded to both E2 (10 pgglrat) and DHT (100 l&g/rat). Epiphyseal cartilage, which showed no sex specific response before surgery, continued to respond to both androgens and eslrogen. The change in patlem of responsiveness seen only after 7 d suggesls a change In differentiation of the bone cells, or in the pool of preosteoblasls in bone marrow. Replenishment with 22 (1 pg/day) in ovarieclomfted rats and with DHT (10 pg/rat/day) in caslraled rals, for 7 days, starling14 fJays after surgery, restored the sex specific paltern of responsiveness in bone and caused a sex specific response In epiphyseal cartilage. not seen Initially. This change In characteristics of cartilage was reminiscent of changes In response previously found in cultured chondroblasts, alter pretreatement with El. These results indicate that the abillly of bone cells lo respond to sex steroids, depends on lheir hormonal milieu, which probably determines their concentrations of Steroid hormone receptors and/or the differentiatlon slate of osteoblasls and osteoblast precursors In bone marrow. These results may conlribute to the understanding necessary for planning optimal regimens of hormonal therapy for osteoporosis.
I oi Aarhus, Denmark, Dept. of Endocrinology and Metabolism, Aarhus Count Hospital, Denmark and Dept. of Human Pharmacology, Astra Draco AS, Lund, Swedm. The pathogenes1s of chronic obstructive pulmonary diseases (COPD) Is unknown. A chronic inflammatory process may be present in the airway wall and treatment with oral cortlcosteroids may slow down the progression In airways obstruction. Among 43 patients wilh COPD, 32 was selected on the basis that clinical improvement was seen after 2 weeks’ treatment with 20 mg prednisolona daily. They had not previously been treated with oral glucocorticbsteroids and had no significant concomitant diseases or osteoporosis. The prednisolone dose was gradually reduced to the dose (range 5.15 mg) that maintained the effect. Twenty-four age- and SSx-matched persons participated as controls. Before prednisolone and after 2.48 and 12 weeks and thereafter every third month blood and urine sample were collected for determination of biochemical markers of bone metabolism (osteocalcin (S-BGP), total alkaline phosphatase (S-T-AP). bone specific alkaline phosphatase (S-BAP). SPTH, @asma-cortlsol, S-vitamin-0 and U.hydroxyproline). Before orednisolone and everv third month bone densitv measurements icotiical and trabecula; bone) were perfoimed. Results after treatment for 18 months are available An Initial raoid decllne in trabecular bone density look place during the first three months and thereafter the reduction slowed down. After six monlhs the reduction was statistically significant. In cortical bone density a small increase occurred. S-SGP and S-T-AP showed significantly lower values after two weeks of treatment with prednisolone and thereafter a small increase occurred, but values remained sianificantlv tower than baseline values. There were no sionificant conelaikms between total accumulated prednisolone do&, bone d&&y or biochemical markers. S-SGP and S-T-AP were the only two biochemical mackers cf bone metabolism that reflected the reduction in bone density measurements and may be of value as markers for development of osteoporosis.
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FUNCTIONALOUTCOW IN ELDERLY HIP FRACTURE PATIENTS TREATED IN A REHABILITATION HOSPITAL. D. Slovik. P. Spaulding Rehabilitation Hospital and Mnassian. nassachusetcs General Hospital, Boston, HA 02114, USA. Hip fractures are the major disabling injuries in In the United States more then elderly osteoporotics. 250,000 hip fractures occur annually at a cost This doesn’t include the cost approaching $10 billion. for long-term care or the personal suffering, morbidity, and mortality associated vith them. At this time, it is controversial as to the best way to rehabilitate this group and get them to their highest functional level. One way is to admit them to a rehabilitation facility. The Spaulding Rehabilitation Hospital (SRH) is a 284 bed rehabilitation hospital caring far patients vith Parients admitted to SRH many different disabilities. must meet the acute hospiral rehabilitation level of indicating they have associated fare auidelines signifiiant medical problems: Last year there were 377 The aatienls admitred to the majar fracture progeam. mean length of stay for this program was 31 t 2 days A subset of 48 were evaluated on (mean * SD). admission, at discharge, and at a 3-month follow up. the using The functional outcome was assessed This has 7 scoees standardized Uniform Dais Set. ranging from complete independence to total assistance. Outcome data shows that following a rehabilitation flmbulate patients the 90x of hosnitalization, iadipendently; ?lX dress lndependentiy, 64% are capable of meal Dreparat ion and light home management,and 60% can negaiiak stairs indep&dently. Pour percent of the patients were discharged to a rate of 4X is nursing home. The long-term institutional signifieanrly less than the 20-30X level documented in Data such as ours supports the idea the literature. tuat a short rehabilitation stay minimizes long-term resource utilization and improves function.
341 A STUDY OF THEEFFECT OF EEL CALCI'IDNIN (EUYVIONIN) ON MNE FAIN INOSI'EOWROSIS. RAJANK T & EVANB W D. RHEUMATISM RESEARCH CENPRE, LWWYPRIDD a DISTRICl’HOSPITAL, FQWYPRIDD, CF374AL & LJh'IVERSITY HOSPITALOF P&ES, CARDIFFCF44XWS WALES. Eone pain is the min clinical symptan in patients with osteoporosis. Even though there may be advantages in using eel Calcitonin, i.e. nasal route of administration smaller dose and greater stability, it is not known whether it is as effective as parenteraly adminiStered salmon Calcitonin in reducing bone pain. This prospective study was carried out over six months in ten post menopausal osteoporotic females (meanage 64 years - range-59 -72) with bone pain due to vertebral fracture. All received eel Calcitoninas a nasal spray (4OIU for each nostril on rising from bzd each day). Bone mineral content was determined using Holcgic Dsnsitaneter prior to starting treatment and again at six months. Spontaneous pain was measured using a visual analcgue scale, 0= no pain & 10= severe pain. ‘WI hour urine hydroxyproline/ creatinine ratios and calcium excretion were also measured before 8 after completing six months treatment. til eel Calcitonin treated patients had significant pain relief, the pain score falling ~XXII7.8521.16 before treatment to 1.2+_2.04 after treatment.. Pain relief began within ten days and continued throughout the duration of therapy. In one individual treatment had to be supplemented by HRTbefore the reduction in hone pain could be sustained. There was no significant change in the bone mass following six months treatment with eel Calcitonin,pretreatment (mean+_sd)0.62620. 14 post-treatment 0.6320.14. No significant change in the biochemical parameters was observed. This study confirms the rapid and sustained analgesic effect of nasal Calcitonin in relieving the bone pain associated with osteoporotic vertebral fracture.
3r12 OSTEOPOROSIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): OSTEOCALCIN AND TOTAL ALKALINE PHOSPl-‘9TASE REFLECT REDUCED BONE DENSITY DURING LONG-TERM TREATMENT WITH PREDNISOLONE. It
343 SEX SPECIFIC RESPONSIVENESS OF RAT BONE TO SEX STEROIDS: MODULATION BY GONADECTOMY AND GONADAL , Endocrine Unit, lchilov STEROIDS. Hospital, Tel Aviv and ‘3eparlment of Hormone Research, The Weizmann Institute of Science, Rehovot, Israel. We have shown previously that gonadal steroids, such as 17ptestosterone (T) and dihydrotesterone (DHT) can estradlol @a). slimulale creatine kinase (CK) specific aclivily in rat diaphyseal bone In a sex speciffo manner; immalure female rats respond only to E2, whereas Immature males respond exclusively to T or DHT. Here we report the effects of Es and DHT on gonadeclomized rats, a model for poslmenopausal osteoporosis. In either ovariectomlzed or castrated rats, dlaphyseal bone lost Its sex specific response by 7 days after surgery, i.e. bones from either gonadectomized male or female rats responded to both E2 (10 pgglrat) and DHT (100 l&g/rat). Epiphyseal cartilage, which showed no sex specific response before surgery, continued to respond to both androgens and eslrogen. The change in patlem of responsiveness seen only after 7 d suggesls a change In differentiation of the bone cells, or in the pool of preosteoblasls in bone marrow. Replenishment with 22 (1 pg/day) in ovarieclomfted rats and with DHT (10 pg/rat/day) in caslraled rals, for 7 days, starling14 fJays after surgery, restored the sex specific paltern of responsiveness in bone and caused a sex specific response In epiphyseal cartilage. not seen Initially. This change In characteristics of cartilage was reminiscent of changes In response previously found in cultured chondroblasts, alter pretreatement with El. These results indicate that the abillly of bone cells lo respond to sex steroids, depends on lheir hormonal milieu, which probably determines their concentrations of Steroid hormone receptors and/or the differentiatlon slate of osteoblasls and osteoblast precursors In bone marrow. These results may conlribute to the understanding necessary for planning optimal regimens of hormonal therapy for osteoporosis.
I oi Aarhus, Denmark, Dept. of Endocrinology and Metabolism, Aarhus Count Hospital, Denmark and Dept. of Human Pharmacology, Astra Draco AS, Lund, Swedm. The pathogenes1s of chronic obstructive pulmonary diseases (COPD) Is unknown. A chronic inflammatory process may be present in the airway wall and treatment with oral cortlcosteroids may slow down the progression In airways obstruction. Among 43 patients wilh COPD, 32 was selected on the basis that clinical improvement was seen after 2 weeks’ treatment with 20 mg prednisolona daily. They had not previously been treated with oral glucocorticbsteroids and had no significant concomitant diseases or osteoporosis. The prednisolone dose was gradually reduced to the dose (range 5.15 mg) that maintained the effect. Twenty-four age- and SSx-matched persons participated as controls. Before prednisolone and after 2.48 and 12 weeks and thereafter every third month blood and urine sample were collected for determination of biochemical markers of bone metabolism (osteocalcin (S-BGP), total alkaline phosphatase (S-T-AP). bone specific alkaline phosphatase (S-BAP). SPTH, @asma-cortlsol, S-vitamin-0 and U.hydroxyproline). Before orednisolone and everv third month bone densitv measurements icotiical and trabecula; bone) were perfoimed. Results after treatment for 18 months are available An Initial raoid decllne in trabecular bone density look place during the first three months and thereafter the reduction slowed down. After six monlhs the reduction was statistically significant. In cortical bone density a small increase occurred. S-SGP and S-T-AP showed significantly lower values after two weeks of treatment with prednisolone and thereafter a small increase occurred, but values remained sianificantlv tower than baseline values. There were no sionificant conelaikms between total accumulated prednisolone do&, bone d&&y or biochemical markers. S-SGP and S-T-AP were the only two biochemical mackers cf bone metabolism that reflected the reduction in bone density measurements and may be of value as markers for development of osteoporosis.
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