Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Study Design: Retrospective cohort. Objective: This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <−2.5. Summary of Background Data: Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements. Methods: A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <−2.5. Results: The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <−2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals. Conclusions: The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.

Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by bone tissue necrosis due to vascular insufficiency, often triggered by corticosteroid use. Steroids are commonly employed in the management of autoimmune diseases, organ transplantation, and COVID-19. Early detection is crucial, as ONFH primarily affects young and middle-aged individuals and often progresses to femoral head collapse if untreated. To evaluate the protective effects of Apelin-13 (Ap-13) on steroid-induced ONFH (SONFH) in a rat model. Thirty-two female Sprague-Dawley rats were randomized into four groups: Control, Ap-13 only, ONFH, and ONFH + Ap-13. SONFH was induced using lipopolysaccharide (LPS) and methylprednisolone (MPS). The treatment group received daily intraperitoneal Ap-13 injections. At the fourth week, radiological, histopathological, immunohistochemical, and biochemical analyses were conducted on femoral heads. Micro-CT showed no significant differences in bone mineral density or trabecular parameters. Histopathology revealed increased osteonecrosis, empty lacunae, and vascular thrombosis in the ONFH group, which were significantly reduced in the ONFH + Ap-13 group (p < 0.05). Ap-13 decreased serum malondialdehyde (MDA) levels (p = 0.0002), reduced caspase-3 expression (p < 0.05), and elevated VEGF expression (p = 0.046), indicating reduced oxidative stress, apoptosis, and enhanced vascularization. Additionally, LDL and triglyceride levels were significantly lower in the Ap-13 treated group (p < 0.05). Apelin-13 demonstrates protective effects against SONFH by reducing oxidative stress, apoptosis, and improving vascularization. It may represent a promising noninvasive therapeutic strategy for early-stage ONFH.

Background and Objectives: Serum albumin has been widely studied as a prognostic marker after geriatric hip fracture, whereas less is known about total protein and the additional prognostic information provided by these markers beyond routine clinical factors. This study examined the associations of preoperative albumin and total protein with one-year mortality in older patients with intertrochanteric femur fractures treated with proximal femoral nailing and assessed whether these markers improved mortality prediction when added to routinely available clinical and laboratory variables. Materials and Methods: This retrospective cohort study included 317 patients aged ≥65 years who underwent proximal femoral nailing for intertrochanteric femur fractures. Clinical variables and admission laboratory parameters, including hemoglobin, creatinine, neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio, albumin, and total protein, were evaluated. The primary outcome was all-cause mortality within one year after surgery. Multivariable logistic regression was used to identify factors independently associated with mortality. The additional prognostic value of albumin and total protein was assessed by changes in the area under the receiver operating characteristic curve (AUC) and likelihood-ratio tests. Results: Among 317 patients, 133 (42.0%) died within one year. Age (adjusted odds ratio [aOR] 1.14 per year, 95% CI 1.09–1.19; p < 0.001), ASA class III (aOR 4.71, 95% CI 1.27–17.47; p = 0.021), time to surgery (aOR 1.27 per day, 95% CI 1.12–1.44; p < 0.001), and log-transformed creatinine (aOR 3.56 per e-fold increase, 95% CI 1.89–6.69; p < 0.001) were independently associated with one-year mortality. Albumin was lower among patients who died (median 3.60 vs. 3.80 g/dL; p = 0.009), but its adjusted association with mortality was not statistically significant and was imprecisely estimated (aOR 0.78, 95% CI 0.37–1.64; p = 0.506). Total protein was also not independently associated with mortality (aOR 1.11, 95% CI 0.68–1.82; p = 0.681). The base clinical model had an AUC of 0.809 (95% CI 0.761–0.854), compared with 0.810 (95% CI 0.764–0.855) after addition of albumin and total protein (ΔAUC = 0.0013, 95% CI −0.0029 to 0.0058; likelihood-ratio p = 0.801). Conclusions: Age, ASA class, time to surgery, and renal function were independently associated with one-year mortality. Although lower preoperative albumin was associated with mortality in unadjusted analysis, its adjusted association was not statistically significant and was imprecisely estimated. In this cohort, there was no clear evidence that adding albumin and total protein provided incremental prognostic value beyond the base clinical model.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.