Vidmantas Alekna

Incidence and direct hospitalisation costs of hip fractures in Vilnius, capital of Lithuania, in 2010

BackgroundFew epidemiological data on hip fractures were previously available in Lithuania. The aim of this study was to estimate the incidence and hospital costs of hip fractures in Vilnius in 2010.MethodsData were collected from the medical charts of all patients admitted to hospitals in Vilnius (population, 548,835) due to new low-energy trauma hip fracture, during 2010. The estimated costs included ambulance transportation and continuous hospitalisation immediately after a fracture, which are covered by the Lithuanian healthcare system.ResultsThe incidence of new low-energy trauma hip fractures was 252 (308 women and 160 men) per 100,000 inhabitants of Vilnius aged 50-years or more. There was an exponential increase in the incidence with increasing age. The overall estimated cost of hip fractures in Vilnius was 1,114,292 EUR for the year 2010. The greatest part of the expenditure was accounted for by fractures in individuals aged 65-years and over. The mean cost per case was 2,526.74 EUR, and cost varied depending on the treatment type. Hip replacement did not affect the overall mean costs of hip fracture. The majority of costs were incurred for acute (53%) and long-term care (35%) hospital stays, while medical rehabilitation accounted for only 12% of the overall cost. The costs of hip fracture were somewhat lower than those found in other European countries.ConclusionThe data on incidence and costs of hip fractures will help to assess the importance of interventions to reduce the number of fractures and associated costs.

Self-reported consequences and healthcare costs of falls among elderly women

BACKGROUND AND OBJECTIVE Although the falls in elderly people lead to serious health consequences, the economic burden is underestimated. The aim of this study was to calculate the medical costs of fall consequences in elderly women. MATERIALS AND METHODS Women aged 65 years and older were interviewed by phone recording the consequences and healthcare procedures related to every fall sustained during the previous 12 months. The healthcare costs were estimated by calculating the sum of costs for all self-reported contacts with medical care providers: ambulance, emergency department, visits to family doctor and other specialists, hospitalisations, and rehabilitation. RESULTS The study population consisted of 878 community-dwelling women (mean age 72.2±4.8 years). Falls were reported by 310 (35.3%) women; one in three of them had fallen twice or more. Of all women who fell, 280 (90.3%) reported their fall resulted in an injury, and 77 (15.3%) falls led to bone fractures. Fear of falling was reported by 72.9% of women. Fall-related medical care was provided to 135 women (43.5% of those fallen), and 18 (5.8%) subjects were hospitalised, mostly for the fracture. The mean estimated healthcare cost was 254 EUR per patient receiving fall-related medical care, and 116 EUR per women fallen. The highest mean cost (1289 EUR) was estimated in falls resulted in hip fracture; the lowest (135 EUR), in nonfracture injury. CONCLUSION The data on the self-reported consequences of falls in elderly women showed a significant number of fall-related injuries and a high cost of healthcare.

The prevalence of Parkinson’s disease among Vilnius inhabitants

In a hospital-based study we investigated the prevalence of Parkinson’s disease among inhabitants of the Vilnius city, the capital of Lithuania. The study group was selected from patients who were diagnosed with Parkinson’s disease during the time frame of 1978-2005. Patients’ time of diagnosis were based on the data of dispensary cards, registration journals and/or other documentation. A questionnaire and Mini Mental State Examination provided data for analysis on the conditions of the patients. The prevalence of Parkinson’s disease in Vilnius is 1.32/1000 inhabitants and is higher in men than in women (p < 0.05). The age of Parkinson’s disease onset in men and women is the same (63.77 ± 0.70 years). The rigidity-tremor form of Parkinson’s disease is the most frequent (76.8% of all cases). The PD prevalence rate in Vilnius inhabitants are close to the mean levels observed in studies made in Finland, Austria, Germany. The prevailing form of Parkinson’s disease is rigidity-tremor.

Parkinson’s disease: the most common diagnostic mistakes in Lithuania

Parkinson’s disease (PD) belongs to group of neurodegenerative diseases. PD diagnosis is clinical, based on these signs: tremor, rigidity, bradykinesia, akinesia or hypokinesia. The aim of the work was to determine the frequency of separate clinical forms of Parkinson’s disease and difficulties at this disease diagnosis. After examining 267 patients, foreseen clinical criterion of Parkinson’s disease correspond 202 (44.0% persons) − 115 women and 87 men and for 65 patients diagnosis of PD was not confirmed, because they did not correspond with accepted criteria of Parkinson’s disease. While analyzing clinical peculiarities of disease we ascertained that rigidity-tremor form of disease prevailed for 152 (75.2%, 86 women and 66 men) patients. The rigidity form was more rare − 28 (13.9%, 13 women and 15 men). Not very frequent was a tremor form of disease -− 22 (10.9%, 16 women and 6 men) patients. According to data of our research, for almost one fourth of patients (65, 24.3%) the diagnosis of Parkinson’s disease was not confirmed after clinical examination. These patients did not correspond with clinical criteria of PD. The data of our research maintain that for almost one fourth (one fourth of what?) (24.3%) the diagnosis was incorrect. Although these patients did not correspond with accepted criteria of PD, they had been treated with antiparkinsonic medications. The PD diagnosis for them was determined only according to separate symptoms: tremor, gait alterations or memory deterioration and behaviour alternations. It must be noted, that symptoms of Wilson’s disease, MSA or brain infarction were estimated as PD. Examining patients at home, we ascertained that not all patients use prescribed L-dopa preparations. A part of patients or their relatives stopped using of this drug independently. We also made note of the fact that urinary incontinence manifested using dopamine agonist ropinirole. This side effect became significant problem for patient himself and for his relatives.

Association of Vitamin D Receptor Gene Variation With Osteoporosis Risk in Belarusian and Lithuanian Postmenopausal Women

Vitamin D receptor (VDR) is one of the main mediators of vitamin D biological activity. VDR dysfunction might substantially contribute to development of postmenopausal osteoporosis (PMO). Numerous studies have revealed the effects of several VDR gene variants on osteoporosis risk, although significant variation in different ethnicities have been suggested. The main purpose of this work was to assess the frequency of distribution of VDR genetic variants with established effect and evaluate their haplotype association with the risk of PMO in a cohort of Belarusian and Lithuanian women. Case group included women with PMO (n = 149), the control group comprised women with normal bone mineral density (BMD) and without previous fragility fractures (n = 172). Both groups were matched for age, height, sex, and BMI—no statistically significant differences observed. VDR gene polymorphic variants (ApaI rs7975232, BsmI rs1544410, TaqI rs731236, and Cdx2 rs11568820) were determined using polymerase chain reaction and restriction fragment length polymorphism. The lumbar spine (L1-L4) and femoral neck BMD was measured using dual-energy X-ray absorptiometry. Association between each VDR variant and PMO risk was assessed using multiple logistic regression. The genotyping revealed statistically significant difference in the rs7975232 genotype frequencies between the patients and the controls (homozygous C/C genotype was overrepresented in patients, p = 0.008). Patients with osteoporosis were also three times more likely to carry the rs1544410 G/G genotype, when compared to controls. We found that rs7975232, rs1544410, and rs731236 variants were in a strong direct linkage disequilibrium (p < 0.0001), suggesting that risk alleles of these markers are preferably inherited jointly. For the bearers of C-G-C haplotype (consisting of rs7975232, rs1544410, and rs731236 unfavorable alleles), the risk of PMO was significantly higher (OR = 4.7, 95% CI 2.8–8.1, p < 0.0001) compared to controls. This haplotype was significantly over-represented in PMO group compared to all other haplotypes. Our findings highlight the importance of identified haplotypes of VDR gene variants. Complex screening of these genetic markers can be used to implement personalized clinical approach for prevention, treatment, and rehabilitation programs.

Vitamin D Level and Activities of Daily Living in Octogenarians: Cross-Sectional Study

Introduction Despite the growing number of octogenarians, little is known about their vitamin D status and activities of daily living (ADL) relations. Objective The aim of this study was to investigate peculiarities of vitamin D and ADL and to assess their relations in octogenarians. Methods A cross-sectional study was performed at the National Osteoporosis Centre located in Vilnius, Lithuania. Community-dwelling ambulatory persons aged ≥80 years were included. Current users of vitamin D supplements were excluded. Total 25 hydroxyvitamin D concentration in serum was measured with Cobas E411. Functional status was assessed by Katz ADL and the Lawton Instrumental Activities of Daily Living (IADL) scales. Subjects were divided into three groups according to age and into two groups according to vitamin D level. One-way analysis of variance with post hoc test was used to determine between-group comparisons. Associations between vitamin D and ADL score, and IADL score were assessed using Spearman’s correlation. Results The study was performed on 153 octogenarians: 81 (52.9%) women and 72 (47.1%) men. The average age of subjects was 83.9 ± 3.2 years. Mean total 25 hydroxyvitamin D concentration was 11.2 ± 7.0 ng/ml; 137 (89.5%) persons had vitamin D deficiency, 12 (7.8%) had insufficiency, and only 4 (2.6%) persons were vitamin D sufficient. Positive weak correlation between total 25 hydroxyvitamin D and ADL score (r = 0.2, p = 0.01) and very weak correlation between total 25 hydroxyvitamin D and IADL score (r = 0.19, p = 0.02) were found. Total 25 hydroxyvitamin D level was correlated with ADL score in women (r = 0.23, p = 0.04). In the 80–84 years group ADL score correlated with total 25 hydroxyvitamin D level (r = 0.23, p = 0.02). Conclusion The majority of investigated octogenarians had vitamin D deficiency. The level of vitamin D was associated with the ADL score. There was no association between the vitamin D level and the IADL score, although a weak correlation was found between vitamin D level and category of food preparation.

The Finite Element Analysis of Osteoporotic Lumbar Vertebral Body by Influence of Trabecular Bone Apparent Density and Thickness of Cortical Shell

Abstract Osteoporosis causes the bone mass loss and increased fracture risk. This paper presents the modelling of osteoporotic human lumbar vertebrae L1 by employing finite elements method (FEM). The isolated inhomogeneous vertebral body is composed by cortical out-er shell and cancellous bone. The level of osteoporotic contribution is characterised by reducing the thickness of cortical shell and elasticity modulus of cancellous bone using power-law dependence with apparent density. The strength parameters are evaluated on the basis of von Mises-Hencky yield criterion. Parametric study of osteoporotic degradation contains the static and nonlinear dynamic analysis of stresses that occur due to physiological load. Results of our investigation are presented in terms of nonlinear interdependence between stress and external load.

Incidence of hip fracture in 2010 in Lithuanian residents over 40 years of age

With the growing size of the elderly population, osteoporotic fractures and disabilities resulting from them have a major impact on health. Several studies have analysed the global burden and the number of fractures caused by osteoporotic process: hip fracture sufferers were estimated at 56 million worldwide, with a female-to-male ratio of 1.6:1 [1-3]. The burden of hip fractures has increased considerably throughout the world over the last few decades as the number of elderly persons has increased [4]. Femur fractures affect particularly elderly people and it is associated with changes of bone density and osteoporosis. Hip fractures have become the international osteoporosis prevalence indicator. However, osteoporosis in Lithuania is still underreported on hospital discharge forms as co-morbidity, even in elderly patients with hip fractures. Very little data are available about the incidence and consequences of fractures in Lithuania [5]. Marija Tamulaitiene1,2, Asta Mastaviciute3, Vidmantas Alekna2,3, Matas Urmanavicius3, Raminta Martinaityte3 1 Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Lithuania; 2 National Osteoporosis Center, Vilnius, Lithuania; 3 Faculty of Medicine, Vilnius University, Lithuania

Patient-Reported Fall Related Health Care Services in Elderly Women

Falls in the elderly is a major public health problem as they can lead to irreversible health, social, and psychological consequences, and a large economic burden. More than one-third of persons 65 years of age and older fall each year, and a half of falls are recurrent. Falls are not only a risk factor for fractures but also for development of traumatic cerebral or visceral hemorrhagia, traumatic pain syndromes, functional limitations, dislocations, soft tissue injuries, excess healthcare costs, and increased mortality. As the population of elderly people is growing fall-related injuries affect a substantial number of older adults.