Prevalence of osteoporosis in India: an observation of 31238 adults

Background: Aim of the study was to determine the prevalence of bone loss (both osteopenia and osteoporosis) at national and regional levels in India.Methods: In this retrospective study, data obtained from in-clinic screening camps conducted for bone loss was analysed. Participants were apparently healthy adults (aged 18 years and above) evaluated for bone mineral density (BMD) using calcaneal quantitative ultrasound (QUS) of left foot. Based on t score of BMD obtained, participants were labelled as normal (T-score <-1 SD), osteopenia (t score-1 to -2.5 SD) and osteoporosis (t score <-2.5 SD).Results: In total, data of 31238 participants was analysed retrospectively. Mean age was 47.8±14.2 years and 47.6% were females. Among females, 38.8% were postmenopausal women (age >50 years). Overall prevalence of osteopenia and osteoporosis was 49.9 and 18.3% respectively. Across East, West, North and South India, the prevalence of osteopenia was 51.3, 47.9, 55.6 and 47.4% respectively whereas prevalence of osteoporosis was 18.4, 16.3, 16.4 and 20.7% respectively. Prevalence of osteoporosis was slightly higher in females than males (19.4 vs 17.3%). Among postmenopausal women, overall osteoporosis prevalence was 33.1% and ranged from 16.9% in North region to 21.8% South region. Prevalence of osteoporosis (37.0 vs 12.5%) was higher in elderly (≥60 years) than adults (<60 years).Conclusions: Among adults, nearly one out of two have osteopenia and one out of five have osteoporosis. Osteoporosis prevalence was higher in the women and in the elderly. Nearly one out of three women in postmenopausal age group have osteoporosis. There is no substantial difference across the four regions of the country. Considering the significant prevalence of low BMD, there is need to increase the awareness about bone health in general population. 

Controversies in the management of intra-articular fractures of distal humerus in adults

Background: The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these patients did not achieve full flexion and extension. However, all these patients had useful range of function, with 20΀-110΀ of flexion and full pronation-supination. As per the staging system of Caja et al., the results were in the range of excellent to good in 72% cases (n=67), fair in 19% (n=18), and poor in 9% patients (n=9). In the second part of study (n=90) dual plate fixation of both columns by orthogonal methods (n=80) and parallel plate fixation in 10 patients was performed. The results were excellent to good in 78 patients (86%). Conclusions: The high rate of union can be achieved in complex intra-articular fractures of distal humerus if the proper principles of stable fracture fixation are followed, i.e., a posterior transolecranon approach and dual fixation of both columns and restoration of the continuity of articular surface. The stability achieved by this technique permits institution of early intensive physiotherapy to restore elbow function