Evaluation of Police General Hospital's Fracture Liaison Service (PGH's FLS): The first study of a Fracture Liaison Service in Thailand

Tanawat Amphansap,Nitirat Stitkitti,Peerachai Dumrongwanich 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.4

Objectives: The purpose of the study was to assess the effectiveness of the Fracture Liaison service (FLS) in preventing secondary fracture and decreasing 1-year mortality rate after osteoporotic hip fracture, in patients at Police General Hospital, Bangkok, Thailand. Methods: A prospective cohort study was conducted. We studied male and female patients, 50 years of age and older, who presented with a fragility fracture around the hip due to low energy trauma and were admitted to Police General Hospital, participating in PGH's Liaison service from April 1, 2014eMarch 30, 2015. The sample size was 75 patients, with a follow up time of 1 year. The data from this study was compared with that of a previous study done by Tanawat A. et al. [9] prior to commencement of the FLS project. Results: After a follow up period of 1 year, the mortality rate was measured to be 10.7% and there was no evidence of secondary fragility fracture. Post-injury bone mineral density follow up and osteoporotic medication treatment rates were 48% and 80%, respectively. Patients who participated in the project were found to have a decreasing rate of secondary fracture from 30% to 0%(P < 0.0001), an increasing post-injuryBMDfollowup rate from 28.3% to 48% (P ¼ 0.0053), and an increase in post-injury osteoporotic medication administration rate from 40.8% to 80% (P ¼ 0.0148), all with statistical significance. However, the 1-year mortality rate was not significant (P ¼ 0.731) when compared to the previous study. Conclusions: Patients with recent hip fractures participating in the Fracture Liaison service had a significantly higher post-injury BMD follow up and osteoporotic medication administration rates. This resulted in a lower risk of secondary fracture than those who did not participate in the Fracture Liaison service at a follow up time of one year.

One-year mortality rate after osteoporotic hip fractures and associated risk factors in Police General Hospital

Tanawat Amphansap,Lertkong Nitiwarangkul 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.1

Objectives: The purpose of this study was to investigate the mortality rate and other associated risk factors a year after diagnosis of osteoporotic hip fracture. Methods: A prospective cohort study was carried out in 120 patients who were at least 50 years of age who presented with a hip fracture caused by a simple fall and were admitted to Police General Hospital in 2013. Background data, mortality rate and associated risk factors were collected and evaluated. Results: There were 88 females (73.33%) and 32 males (26.67%). The average age was 79.4 years. Eleven patients were deceased by the end of this study. The mortality rate was about 3.3 times higher when compared to the general population in the same age range (9.2% vs 2.28%). The survival rates for both sexes at 6 weeks, 6 months and 12 months after fracture were 94.2%, 93.3% and 90.8%, respectively. Higher mortality was associated with non-operative treatment only. Patients who were treated non-operatively had a 3.93 times higher mortality risk when compared to those who were treated operatively (23.8% vs 6.1%). Conclusions: This study shows that the one-year mortality rate of osteoporotic hip fracture patients who were 50 years or older was 9%. However, the rate increased after an osteoporotic hip fracture, especially within the first year post-fracture. Higher mortality was associated with non-operative treatment only while the other variables were not.

The effectiveness of Police General Hospital’s fracture liaison service (PGH’s FLS) implementation after 5 years: A prospective cohort study

Tanawat Amphansap,Nitirat Stitkitti,Alisara Arirachakaran 대한골다공증학회 2020 Osteoporosis and Sarcopenia Vol.6 No.4

Objectives: The purpose of the study is to assess the effectiveness of fracture liaison service (FLS) after 5-year implementation to close the secondary fracture care gap, ensuring that patients receive osteoporosis assessment, intervention, and treatment, therefore, reducing the fracture risk at Police General Hospital (PGH). Methods: A prospective cohort study was conducted. We studied male and female, ≥ 50 years old who presented with a fragility hip fracture and participated in PGH’s FLS from April 1, 2014–March 31, 2019 (5 years implementation). The sample size was 353 patients, with 1-year follow-up. The data were compared with a previous study, before the commencement of the FLS. Results: After 1-year follow up, the mortality rates were 5.95% and there were only 8 patients who had secondary fractures (2.93%), which showed a decrease of 30% from before FLS implementation. Post-injury bone mineral density (BMD) rates were increased from 28.33% to 85.84%, osteoporosis treatment rates were increased from 40.8% to 89.38%, and the time to surgery and hospitalization decreased from 7.9 to 5.0 days, and 23.2 to 19.6 days, respectively, all with statistical significance (P < 0.001). However, the 1-year mortality rates were not significant when compared to the previous study. Conclusions: Patients with fragility hip fractures participating in FLS after 5-year implementation at PGH had significantly higher post-injury BMD and osteoporosis treatment rates and significantly shorter in time to surgery and hospitalization. This showed that secondary fracture rates were lower than before the project at 1-year of follow up.

Efficacy of plain cholecalciferol versus ergocalciferol in raising serum vitamin D level in Thai female healthcare workers

Tanawat Amphansap,Atiporn Therdyothin,Nitirat Stitkitti,Lertkong Nitiwarangkul,Vajarin Phiphobmongkol 대한골다공증학회 2022 Osteoporosis and Sarcopenia Vol.8 No.4

Objectives: To compare the efficacy of cholecalciferol and ergocalciferol in raising 25-hydroxyvitamin D (25(OH)D) level in Thai female healthcare workers. Methods: A randomized control trial was conducted in healthy female healthcare workers. Randomization allocated the participants into vitamin D2 group (N = 43), receiving ergocalciferol 20,000 IU weekly and vitamin D3 group (N = 40), receiving cholecalciferol 1000 IU daily for 12 months. Venous blood sample was collected at baseline, 6 and 12 months for serum 25(OH)D, parathyroid hormone and calcium. Compliance was also assessed. Results: The mean age of the participants was 50.6 ± 9.9 and 50.9 ± 8.4 years in vitamin D2 and D3 groups (P = 0.884). The mean 25(OH)D levels were 16.91 ± 6.07 ng/mL and 17.62 ± 4.39 ng/mL (P = 0.547), respectively. Both groups had significant improvement in 25(OH)D level at 6 months (from 16.91 ± 6.07 to 21.67 ± 5.11 ng/mL and 17.62 ± 4.39 to 26.03 ± 6.59 ng/mL in vitamin D2 and D3 group). Improvement was significantly greater with cholecalciferol (P = 0.018). The level plateaued afterwards in both groups. Only cholecalciferol could increase 25(OH)D in participants without vitamin D deficiency (6.88 ± 4.20 ng/mL increment). Compliance was significantly better in vitamin D2 group (P = 0.025). Conclusions: Daily cholecalciferol supplementation resulted in a larger increase in serum 25(OH)D level during the first 6 months comparing to weekly ergocalciferol. While vitamin D3 could increase serum 25(OH)D level in all participants, vitamin D2 could not do so in participants without vitamin D deficiency.

Reply on “Exploring optimal supplementation for people with vitamin D deficiency”

Tanawat Amphansap,Atiporn Therdyothin,Nitirat Stitkitti,Lertkong Nitiwarangkul,Vajarin Phiphobmongkol 대한골다공증학회 2023 Osteoporosis and Sarcopenia Vol.9 No.1

Comparison of bone mineral density and vertebral fracture assessment in postmenopausal women with and without distal radius fractures

Tanawat Amphansap,Chayaphong Rattanaphonglekha,Jaruwat Vechasilp,Nitirat Stitkitti,Kamonchalat Apiromyanont,Atiporn Therdyothin 대한골다공증학회 2021 Osteoporosis and Sarcopenia Vol.7 No.4

Objectives: To compare bone mineral density (BMD) in Thai postmenopausal women with and without distal radius fracture, and to investigate the role of vertebral fracture assessment (VFA) in diagnosing osteoporosis after distal radius fracture. Methods: A cross-sectional study was conducted in Thai postmenopausal women with and without distal radius fracture. BMDs of the femoral neck (FN), total hip (TH), lumbar spine (LS), and VFA were obtained within 2 weeks of injury. BMD were compared between groups. Participants were classified into osteoporosis, osteopenia or normal using BMD alone, and BMD plus VFA, where a mere presence of vertebral compression fracture indicated osteoporosis. Results: Fifty postmenopausal women with distal radius fractures and 111 non-fracture postmenopausal women participated. The mean BMD was significantly lower at all sites in the fracture group (FN BMD 0.590 ± 0.075 vs 0.671 ± 0.090, p = 0.007; TH BMD 0.742 ± 0.103 vs 0.828 ± 0.116, P = 0.009; LS BMD 0.799 ± 0.107 vs 0.890 ± 0.111, P = 0.009 in the fracture vs non-fracture group respectively). VFA increased the prevalence of osteoporosis from 16 (32%) to 23 (46%) in the fracture group, and 7 (6.31%) to 17 (16.22%) in the non-fracture group, with a number needed to treat 9. Objectives: To compare bone mineral density (BMD) in Thai postmenopausal women with and without distal radius fracture, and to investigate the role of vertebral fracture assessment (VFA) in diagnosing osteoporosis after distal radius fracture. Methods: A cross-sectional study was conducted in Thai postmenopausal women with and without distal radius fracture. BMDs of the femoral neck (FN), total hip (TH), lumbar spine (LS), and VFA were obtained within 2 weeks of injury. BMD were compared between groups. Participants were classified into osteoporosis, osteopenia or normal using BMD alone, and BMD plus VFA, where a mere presence of vertebral compression fracture indicated osteoporosis. Results: Fifty postmenopausal women with distal radius fractures and 111 non-fracture postmenopausal women participated. The mean BMD was significantly lower at all sites in the fracture group (FN BMD 0.590 ± 0.075 vs 0.671 ± 0.090, p = 0.007; TH BMD 0.742 ± 0.103 vs 0.828 ± 0.116, P = 0.009; LS BMD 0.799 ± 0.107 vs 0.890 ± 0.111, P = 0.009 in the fracture vs non-fracture group respectively). VFA increased the prevalence of osteoporosis from 16 (32%) to 23 (46%) in the fracture group, and 7 (6.31%) to 17 (16.22%) in the non-fracture group, with a number needed to treat 9. Conclusions: Postmenopausal women with distal radius fractures had lower BMD. Incorporating VFA into diagnosis of osteoporosis increased the prevalence of osteoporosis in both fracture and non-fracture groups. Postmenopausal women aged 50 years or older with distal radius fracture are a good target for the investigation of osteoporosis.

Discovering ‘Missing Pieces of Jigsaw’ in Evolution: New Species of Plants and Conservation

Tanawat Chaowasku 한국화훼학회 2024 한국화훼학회 정기총회 및 학술발표회 자료집 Vol.32 No.1

Quality of life and factors that affect osteoporotic hip fracture patients in Thailand

Tanawat Amphansap,Puttapoom Sujarekul 대한골다공증학회 2018 Osteoporosis and Sarcopenia Vol.4 No.4

Objectives: The aim of this study was to report the health-related quality of life (HRQoL) over the first year after osteoporotic hip fracture and to identify the factors associated with HRQoL in Police General Hospital in Thailand. Methods: A prospective cohort study was conducted. 139 subjects who had osteoporotic hip fracture were recruited, which they will be assessed during the preinjury recall and at 3, 6, and 12 months after the fracture. HRQoL was measured as Thailand health state utility values (THSUVs), which derived from EuroQol-5-Dimension-3-Level. Factors associated with the change in QoL were analyzed. Results: One hundred thirty-six patients with a hip fracture were included for analysis. Their mean age was 82 ± 11 years old. The mean ± standard deviation (SD) of QoL score and EQ VAS at 12-month followup period were lower than before the fracture ([0.68 ± 0.105 vs. 0.55 ± 0.183] and [85 ± 10.5 vs. 79 ± 19.2]). The mean ± SD of QoL score and EQ VAS, compared before and after the fracture was estimated at 0.13 ± 0.164 and 6 ± 14.7 (P ¼ 0.01). The positive influences on the change in QoL score were present in the subject, who are younger than 80 years old, had normal or high body mass index (BMI), and had operative treatment. Conclusions: Osteoporotic hip fractures incurred substantial loss in HRQoL which was markedlyimpaired at first 3 months after hip fracture and after that HRQoL was improved but did not return to prefracture levels. So primary prevention of fall is more important. The changes in HRQoL, was influenced by age, BMI, and operative treatment.

The distribution pattern of the dorsal cutaneous nerves of the foot and its clinical implications

Chirapat Inchai,Tanawat Vaseenon,Yasuhito Tanaka,Pasuk Mahakkanukrauh 대한해부학회 2020 Anatomy & Cell Biology Vol.53 No.2

Iatrogenic injury to subcutaneous nerves on the dorsum of the foot is an established risk factor during the surgical procedures resulting in postoperative pain, sensation loss and painful neuroma. Previous studies have reported on the distribution pattern of the superficial peroneal, deep peroneal and sural nerves (SNs) and their branches with various classifications about specific populations. The purpose of the present study was to evaluate the distribution pattern and classification of the nerves on the dorsum of the foot and analyze the location of these nerves into five zones with clinical implications. Fifty-four lower limbs of fresh frozen cadavers were used in the present study. The anatomical patterns of the superficial peroneal, deep peroneal, SN and their branches were classified into eight, two and five patterns respectively. Type VI pattern, a classic distribution pattern of the superficial peroneal nerve was the most frequent type with a prevalence of 13 limbs (25.00%). In Zone 5, where the arthroscopic portal placements for the first metatarsophalangeal joint arthrodesis, 29 limbs (55.77%) showed three nerve branches located in this zone. The results of the present study provide anatomical knowledge that may help the surgeon to choose the appropriate treatment for their patients and reducing the rate of complications in surgery.

Jejunal Dieulafoy’s lesion resembling subepithelial mass resulting in profound gastrointestinal hemorrhage

Thanaboon Chaemsupaphan,Tanawat Geeratragool,Napat Angkathunyakul,Arissa Phothisirisakulwong,Monthira Maneerattanaporn 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.4

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