Unveiling the Metabolic Mystery of Fragility Hip Fracture in Indian Patients: A Histomorphometric and Biochemical Correl
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ORIGINAL ARTICLE
Unveiling the Metabolic Mystery of Fragility Hip Fracture in Indian Patients: A Histomorphometric and Biochemical Correlation Mohammad Nasim Akhtar1,3 · Sonia Gon2,3 · Bhaskar Sen1,3 · Lawrence Kisku1,3 · Riddhideb Barman1,3 · Sanjay Keshkar1,3 Received: 21 July 2020 / Accepted: 3 September 2020 © Indian Orthopaedics Association 2020
Abstract Background High prevalence of hypovitaminosis D is being reported in Indian patients with fragility hip fracture. The gold standard to diagnose osteoporosis and osteomalacia is bone histomorphometry. There is no study evaluating histopathological histomorphometry in Indian fragility hip fracture patients. The purpose of the study was to evaluate fragility hip fracture patients for histopathological osteomalacia and osteoporosis by histomorphometry and to correlate histopathological findings with biochemical hypovitaminosis D. Materials and Methods A total of 55 patients of fragility hip fractures recruited for prospective cross-sectional study. During definitive fracture fixation of these fragility hip fractures, bone biopsy taken from neck region of femur by a novel approach for histomorphometry. Histomorphometric analysis was based on three indices, namely osteoid seam width, osteoblast surface, and osteoid surface. We also analysed blood bone biochemistry and correlated with bone histomorphometry. Results In fragility hip fracture patients, the prevalence of histomorphometric osteoporosis and osteomalacia were very low (only 9.4% had osteoporosis and none had osteomalacia) however in blood bone biochemistry, we found high prevalence (85.5%) of hypovitaminosis D. We also noted significant changes when correlated bone histomorphometry with different blood bone biochemistry. Conclusion Indian patients with fragility hip fracture were found to have high prevalence of biochemical hypovitaminosis D but unlike western literature, there was low prevalence of histomorphometric osteoporosis with no evidence of histomorphometric osteomalacia. Correct knowledge about metabolic status of fragility hip fracture is required to improve outcome, decrease complications and to optimise cost of the treatment. Keywords Fragility hip fracture · Bone histomorphometry · Hypovitaminosis D · Osteomalacia · Osteoporosis
Introduction Fragility hip fracture is a common orthopaedic injury. Surgery for fragility hip fracture is one of the most common orthopaedic operation performed worldwide including India, and
it affects all strata of society. Fragility fractures are fractures that result from ‘low energy’ trauma that would not ordinarily result in fracture. The World Health Organization (WHO) has quantified this as forces equivalent to fall from a standing height or less. Fragility fractures occur most commonly in
* Mohammad Nasim Akhtar [email protected]
Riddhideb Barman [email protected]
* Sanjay Keshkar [email protected]
1
Sonia Gon [email protected]
Department of Orthopaedics, ESI PGIMSR, ESIC Medical College and Hospital, Joka, Kolkata 700104, India
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