Sattaya Rojanasthien

Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand.

The purpose of the study was to investigate 10-yr mortality and associated factors after osteoporotic hip fracture. A prospective cohort study of mortality and associated factors was carried out in patients who sustained hip fracture and were admitted to Chiang Mai University Hospital from 1998 through 2003. Eligibility criteria were defined as age over 50yr, hip fracture caused by simple fall, and Singh index of 3 or less.Mortality rates at 3, 6, 12, 24, 36, 60, 96, and 120mo were 10%, 14%, 18%, 27%, 32%, 45%, 55%, and 68%, respectively. One-year mortality rates were 31% in males and 16% in females. The median survival time was 6yr. Ten-year mortality was 68%. Factors correlated with higher mortality were male gender, age greater than 70yr, and nonoperative treatment. Mortality after osteoporotic hip fracture in Thais was extremely high, especially in the first year. It was about 8 times higher than that in the age-adjusted general population.

Chondroitin sulfate epitope (WF6) and hyaluronic acid as serum markers of cartilage degeneration in patients following anterior cruciate ligament injury

Serum chondroitin sulfate epitope (WF6) and hyaluronic acid (HA) levels were determined to be of clinical relevance to an anterior cruciate ligament (ACL) injury. This cross-sectional study recruited participants from two distinct groups. Group A was comprised of 74 healthy controls, and group B consisted of 33 ACL injury patients. Serum samples were taken and assayed by a competitive immunoassay with monoclonal antibody WF6. Serum HA was also determined by an ELISA-based assay using biotinylated HA-binding proteins. Both groups A and B shared similar values of age, body mass index, white blood cell count and percentage of polymorphonuclear cells. ESR levels were also shown to be within normal limits. The serum WF6 epitope levels of group B were significantly higher than those of group A, whereas serum HA levels were not different between the two groups. The serum WF6 epitope level is more sensitive to changes in articular cartilage due to a non-inflammatory instability condition than the serum HA level, and should prove to be one of the most promising assays for early post-traumatic arthritis detection.

Effect of fat mass and lean mass on bone mineral density in postmenopausal and perimenopausal Thai women

Background The purpose of this study was to investigate the association between fat mass, lean mass, and bone mineral density (BMD) in postmenopausal and perimenopausal Thai women. Methods A cross-sectional study was conducted in 1579 healthy Thai women aged 40–90 years. Total body, lumbar spine, total femur, and femoral neck BMD and body composition were measured by dual x-ray absorptiometry. To evaluate the associations between fat mass and lean mass and various measures of BMD, multivariable linear regression models were used to estimate the regression coefficients for fat mass and lean mass, first in separate equations and then with both fat mass and lean mass in the same equation. Results Among the study population, 1448 subjects (91.7%) were postmenopausal and 131 (8.3%) were perimenopausal. In postmenopausal women, after controlling for age, height, and duration of menopause, both fat mass and lean mass were positively correlated with BMD when they were analyzed independently of each other. When included in the same equation, both fat mass and lean mass continued to show a positive effect, but lean mass had a significantly greater impact on BMD than fat mass at all regions except for total body. Lean mass but not fat mass had a positive effect on BMD at all skeletal sites except the lumbar spine, after controlling for age and height in perimenopausal women. Conclusion Lean mass had a significant beneficial effect on BMD in both postmenopausal and perimenopausal women and can be considered as one of the determinants of bone mass. The effect of the fat mass was related to menopausal status, but only demonstrated a positive impact in perimenopausal women.

Hyaluronan production and chondrogenic properties of primary human chondrocyte on gelatin based hematostatic spongostan scaffold

BackgroundAutologous chondrocyte transplantation is a promising technique for treatment of cartilage defects. Three dimensional chondrocyte cultures on a scaffold are widely used to retain the chondrogenic phenotype. Using a biodegradable gelatin scaffold is one option for the cell delivery system, but molecular and histological studies of the method have not yet been done.MethodsWe evaluated the chondrogenic property of the primary human chondrocyte on a gelatin scaffold as compared to a collagen scaffold over a period of 21 days. We examined the production of glycosaminoglycan by quantitative and histological analysis. Gene expression of cartilage-associated molecules was assessed by quantitative RT-PCR.ResultsThe gelatin scaffold showed the ability to promote chondrocyte expansion, chondrogenic phenotype retention at molecular and mRNA levels.ConclusionsThis scaffold is thus suitable for use as an in vitro model for chondrocyte 3D culture.

Increasing Incidence of Hip Fracture in Chiang Mai, Thailand

Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50 yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1 to 2.4), with a mean age of 76.7 yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70 yr or older. The highest incidence of hip fracture was observed in patients older than 85 yr (1239). At 6 mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75 yr. In patients older than 84 yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed.

Impact of bone marker feedback on adherence to once monthly ibandronate for osteoporosis among Asian postmenopausal women.

Aim:  This study assesses the impact of serum carboxy‐terminal collagen crosslinks (CTX) bone marker feedback (BMF) on adherence to ibandronate treatment in Asian postmenopausal women with osteoporosis.AIM This study assesses the impact of serum carboxy-terminal collagen crosslinks (CTX) bone marker feedback (BMF) on adherence to ibandronate treatment in Asian postmenopausal women with osteoporosis. METHODS This was a 12-month (6-monthly phased), randomized, prospective, open-label, multi-center study conducted in 596 (of 628 enrolled) postmenopausal women with osteoporosis (< or = 85 years old) who were naïve, lapsed, or current bisphosphonate users. Patients were randomized into two arms: serum CTX BMF at 3 months versus no-BMF. Once-monthly 150 mg ibandronate tablet was administered for 12 months and adherence to therapy was assessed at 6 and 12 months. In addition, patient satisfaction and safety of ibandronate treatment were also assessed. RESULTS Serum CTX BMF at 3 months showed no impact on adherence. The proportions of adherent patients were comparable in the BMF versus no-BMF arms (92.6%vs. 96.0%, P = 0.16); overall, serum CTX levels were similar for adherent and non-adherent patients. However, BMF patients felt more informed about their osteoporosis (P < 0.001) and more satisfied (P < 0.01) than no-BMF patients. CONCLUSIONS The Asian postmenopausal osteoporosis patients in this study had a high adherence rate to once-monthly ibandronate therapy. Use of serum CTX BMF had no further impact on increasing adherence, but increased treatment satisfaction.

Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment.

Symptomatic slow‐acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium‐ to long‐term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once‐daily dose (1500 mg), which consistently delivers the plasma levels of around 10 μmol/L required to inhibit interleukin‐1‐induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non‐steroidal anti‐inflammatory drugs (NSAIDs), while non‐crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease‐modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long‐term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium‐term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.

Contribution of Android and Gynoid Adiposity to Bone Mineral Density in Healthy Postmenopausal Thai Women

Dual-energy X-ray absorptiometry (DXA) is one of the major tools for assessing the whole body and regional body composition and body adiposity. Various body composition parameters including android fat mass (AFM), gynoid fat mass (GFM), and android-to-gynoid fat ratio (AG fat ratio) obtained from whole body DXA can be used as a reliable surrogate marker for regional body composition analysis. This study aimed to explore the contribution of android and gynoid adiposity to bone mineral density (BMD) in healthy postmenopausal Thai women. This cross-sectional study enrolled 1448 healthy Thai women, ages 40-90 without medication history or known disease affecting the BMD. Lumbar spine (LS), total femur, and femoral neck BMDs, AFM, GFM, and AG fat ratio were measured by DXA. To evaluate the contribution of android and gynoid adiposity with various measures of BMDs, univariable and multivariable linear regression analyses were used to estimate the regression coefficients. AFM, GFM, and AG fat ratio had a significant positive association with BMD of all measured sites (p < 0.001) in the univariate analysis. The strongest association was found between AG fat ratio and LS BMD (β = 0.156, p ≤ 0.001). In multivariate linear regression analysis, the results continued to show a positive association between AFM and GFM at all skeletal sites after adjusting for age, height, and total body lean mass. Relationship between AG fat ratio and BMD was found only in LS region. GFM had a strongest positive effect with BMD at the LS, total femur, and femoral neck regions. Higher android and gynoid adiposity was associated with higher BMD. GFM rather than AFM shows the strongest positive association with BMDs in postmenopausal Thai women.

3D CAD/reverse engineering technique for assessment of Thai morphology: Proximal femur and acetabulum

PURPOSE To assess morphological parameters of proximal femur and acetabulum in Thai population with three-dimensional measurement technique, and to analysis of collateral side symmetric, gender difference, and correlation between morphometric parameters. METHODS Investigation was performed in 240 femurs. All three-dimensional femur models were acquitted from 64-slice spiral CT scanner. Morphometric parameters under consideration included acetabular diameter, femoral head diameter, shaft isthmus location, intramedullary canal diameter, diaphyseal diameter, femoral head height, femoral neck isthmus, femoral neck length, neck shaft angle, bow angle, and anteversion angle. All parameters were measured based on functions and least-square regression function in CAD software. Obtained measured data were then used for analysis of collateral side symmetric, gender difference, correlation between morphometric parameters, and compared with other populations. RESULTS Female had a smaller dimension compared with male in most of the parameters. No significant difference was observed between left and right femurs. High correlation pairs of morphometric parameters included femoral head diameter-acetabular diameter, femoral head diameter-neck isthmus diameter, femoral head diameter-diaphyseal diameter at shaft isthmus level, acetabular diameter-neck isthmus diameter, neck isthmus diameter-diaphyseal diameter at shaft isthmus level, and acetabular diameter-diaphyseal diameter at shaft isthmus level. Some morphometric parameters of Thai are smaller than other Caucasian, and some Asian nation, i.e. femoral head diameter, femoral neck length, and femoral head height. CONCLUSIONS This study provides essential morphometric data for various orthopedic implant designs relating to proximal femur region.