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A new study published in the Journal of Bone and Mineral Research found that when older patients with osteoporotic hip fractures are given zoledronic acid during their initial hospital stay, it greatly lowers their all-cause mortality and future vertebral fractures.

High 1-year death rates are linked to osteoporotic hip fractures, around 20% to 25% in women and 33% to 35% in men. Only 8% to 10% of patients receive zoledronic acid within a year following a fracture, despite the proven ability of this medication to lower fracture and death risks. This study evaluated the impact of zoledronic acid inpatient therapy on death rates and the risk of recurrent fractures in patients who were admitted for a first hip fracture.

Between January 1, 2016 and March 15, 2023 individuals with acute fragility hip fractures admitted to Massachusetts General Brigham facilities were identified. At the time of the fracture, the patients included had normal calcium levels, no postoperative renal damage, and were not actively using antiosteoporosis medicine. Propensity score matching was performed in a 1:1:3 ratio between patients who got zoledronic acid and the patients who did not get antiosteoporosis medication within the first year following their initial fracture. All-cause mortality and recurrent vertebral, nonvertebral, or contralateral hip fractures for a maximum of 24 months after the index fracture were the main research outcomes.

• A total of 652 patients were given zoledronic acid and matched with 1926 people who got no antiosteoporosis medication. The patients who received zoledronic acid had a considerably reduced all-cause death rate than the ones who received no treatment.
• Subgroup analysis revealed that women in the zoledronic acid group had much lower mortality than males in the untreated group, despite the difference between the two groups being not significant.
• Furthermore, patients under the age of 90 who got zoledronic acid had considerably decreased mortality, regardless of the differences between groups above the age of 90 being not significant.
• The rates of future spinal compression fractures were reduced in the zoledronic acid group. There were no significant differences between groups in the incidence of new contralateral hip fractures or nonvertebral fractures.
• When it came to unfavorable outcomes, the rates of nonunion were comparable in the treated and untreated groups, and the zoledronic acid group did not see any incidences of atypical femoral fractures or osteonecrosis of the jaw.

Overall, the outcomes of this study support that zoledronic acid given inpatient is advantageous for osteoporotic hip fractures.

Reference:

Fan, W., Sun, X., Leder, B. Z., Lee, H., Ly, T. V., Pu, C. T., Franco-Garcia, E., & Bolster, M. B. (2024). Zoledronic acid for hip fracture during initial hospitalization. In Journal of Bone and Mineral Research. Oxford University Press (OUP). https://doi.org/10.1093/jbmr/zjae101

Researchers have found in a new study that trueness of shade matching with intraoral scanners was low compared to spectrophotometers.Therefore Shade determination with intraoral scanners is not recommended. The study has been published in the Journal of Esthetic and restorative Dentistry.

The risk of being born with a major heart defect is 36% higher in babies who were conceived after assisted reproductive technology, such as in vitro fertilisation (IVF), according to results of a very large study published in the European Heart Journal.

Researchers say the finding is important since congenital heart defects are the most common form of birth defects, and some of them are associated with life threatening complications.

The study also shows that the increase in risk is particularly associated with multiple births which are more common in assisted reproduction.

The study was led by Professor Ulla-Britt Wennerholm from the University of Gothenburg in Sweden. She said: “Previous research shows that there are increased risks for babies conceived with the help of assisted reproductive technology. These include preterm birth and low birth weight. We wanted to investigate whether the risk of heart defects was higher for babies born following assisted reproduction.”

The research included all liveborn children born in Denmark between 1994 and 2014, all children born in Finland between 1990 and 2014, those born in Norway between 1984 and 2015 and those born in Sweden from 1987 to 2015; more than 7.7 million in total.

Researchers compared data on babies born following assisted reproduction, including IVF, intracytoplasmic sperm injection (ICSI) and embryo freezing, with data on babies conceived naturally.

They assessed how many liveborn children in each group were diagnosed with a major heart defect or with a serious heart defect either in the womb or in the first year of life. They took into account other factors that can increase the risk of congenital heart defects, such as child’s year of birth, country of birth, mother’s age at delivery, if the mother smoked during pregnancy, or if the mother had diabetes or heart defects.

This showed that heart defects were around 36% more common in babies born after assisted reproduction, compared to babies conceived without such treatment (absolute risk 1.84% versus 1.15%). This risk was similar regardless of the type of assisted reproduction used (IVF or ICSI, fresh or frozen embryos). However, the risk was greater for multiple births following assisted reproduction compared to singleton births following assisted reproduction (2.47% versus 1.62%).

Professor Wennerholm said: “We already know that babies born after assisted reproductive technology have a higher risk of birth defects in general however, we have found a higher risk also in congenital heart defects, the most common major birth defect.

“The fact that the risk of heart defects is similar regardless of the type of assisted reproduction used may indicate that there is some common factor underlying infertility in parents and congenital heart disease in their babies.

“Congenital heart defects can be extremely serious requiring specialist surgery when babies are very young, so knowing which babies are at the greatest risk can help us diagnose heart defects as early as possible and ensure the right care and treatment are given. More and more people are conceiving with the help of assisted reproductive technology, so we might expect to see increases in cases of congenital heart defects worldwide.”

In an accompanying editorial [2] Dr Nathalie Auger from University of Montreal Hospital Research Centre in Canada and colleagues said: “Assisted reproductive technology is a popular intervention in reproductive medicine, with these procedures accounting for 2% to 8% of births depending on the country. While most neonates born after assisted reproductive technology are healthy, these procedures are not without risks.

“In one of the largest studies to date, the researchers found that assisted reproductive technology was associated with the risk of major heart defects diagnosed prenatally or up to one year of age.

“Patients who use assisted reproductive technology tend to differ from the general population. These patients may have underlying morbidities that affect both fertility and the risk of heart defects.”

Reference:

Nona Sargisian, Max Petzold, Eva Furenäs, Mika Gissler, Anne Lærke Spangmose, Sara Malchau Lauesgaard, Signe Opdahl, Anja Pinborg, Anna-Karina A Henningsen, Kjersti Westvik-Johari, Kristiina Rönö, Christina Bergh, Ulla-Britt Wennerholm, Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study, European Heart Journal, 2024;, ehae572, https://doi.org/10.1093/eurheartj/ehae572.

Researchers reported that levels of anti-BP180 autoantibodies may be the best marker for monitoring the disease activity of bullous pemphigoid (BP). BP is an autoimmune skin disorder in which autoantibodies attack parts of the skin, specifically the BP180 and BP230 proteins. A recent study was published in JAMA Dermatology by Po-Yi Chou and colleagues. This study aimed to evaluate the relationship over time between the titers of anti-BP180 and anti-BP230 antibodies in patients with BP disease, concerning their severity.

Researchers from USF Health Morsani College of Medicine in Tampa, FL compared the cumulative cost of pharmacotherapy with GLP-1 agonists to onetime surgical procedures, sleeve gastrectomy and Rou-en-Y gastric bypass, providing important new insights into cost considerations surrounding surgical and drug treatment of obesity.

They found that cost of taking weekly injections of popular anti-obesity medications liraglutide or semaglutide exceeds that of metabolic and bariatric surgery in less than a year. The results of recent analysis has been published in the journal Surgical Endoscopy.

“Bariatric surgery offers a more permanent and rapid resolution to obesity and metabolic syndrome, with cost-saving benefits in the long-term,” the researchers wrote. “Bariatric has consistently demonstrated a significant reduction in the use and cost of medications post-bariatric surgery, a decrease in clinic and emergency room visits, and a decreased all-cause mortality, which contributes to a significant cost-saving.”

Ann M. Rogers, MD, ACS FASMBS, President, American Society for Metabolic and Bariatric Surgery (ASMBS), commented: “Studies consistently show the efficacy of metabolic surgery in achieving long-term diabetes remission and substantial weight loss, far surpassing results achieved with medical management or diets and exercise alone. This not only results in better health, but in significant cost savings too — yet another reason for patients to consider surgery and insurers to expand access to the gold standard of obesity treatment.”

The ASMBS reports that in 2022 nearly 280,000 metabolic and bariatric procedures were performed in the U.S., which represents only about 1% of those who meet eligibility requirements based on BMI. According to the U.S. Centers for Disease Control and Prevention (CDC), the U.S. obesity rate is about 40%. Severe obesity affects about 1 in 10.

Reference:

Docimo S Jr, Shah J, Warren G, Ganam S, Sujka J, DuCoin C. A cost comparison of GLP-1 receptor agonists and bariatric surgery: what is the break even point? Surg Endosc. 2024 Sep 16. doi: 10.1007/s00464-024-11191-1.