#Vertebral Fracture

[gauricmi]

The Global Spinal Imaging Market is Anticipated to Witness High Growth Owing to Rising Incidence of Spinal Disorders

The global spinal imaging market encompasses imaging modalities and procedures used for evaluating spinal disorders and spine-related conditions. Key modalities include X-ray, CT myelography, MRI, nuclear imaging, and ultrasound. Spinal imaging provides detailed anatomical information and helps diagnose spinal disorders effectively. It plays a vital role in evaluating degenerative conditions, infections, masses, fractures, structural deformities, and post-surgical assessment. The growing burden of spinal disorders due to lifestyle changes and rising geriatric population is a key factor fueling demand for spinal imaging procedures worldwide. The Global spinal imaging market is estimated to be valued at US$ 2.10 BN in 2024 and is expected to exhibit a CAGR of 5.4% over the forecast period 2024 To 2031. Key Takeaways Key players operating in the Global Spinal Imaging Market Growth are Shimadzu Corp., FUJIFILM, Hitachi, Ltd., Toshiba Medical Systems, Inc., GE Healthcare, Koninklijke Philips N.V., Siemens Healthineers, Canon Medical Systems Corp., Bruker, and Mediso Ltd. These players are focusing on new product launches and offering advanced imaging modalities to bolster their market position. Major companies are also expanding their geographical presence in emerging markets through partnerships and acquisitions. For instance, in 2021, FUJIFILM acquired Hitachi's diagnostic imaging business to strengthen its position in the medical system business globally. The key opportunities in the market include increasing adoption of hybrid imaging systems, growing demand for minimally invasive procedures, and integration of AI and analytics with spinal imaging modalities. Hybrid imaging systems combine anatomical and functional imaging which help provide better visualization during diagnosis and treatment planning. Moreover, there is high potential for spinal imaging in emerging regions such as Asia Pacific, Latin America, and Middle East & Africa. Factors such as increasing healthcare expenditure, growing awareness about advanced spine care, and initiatives by market players will aid the adoption of spinal imaging in these markets over the forecast period. Market Drivers Rising incidence of spinal disorders due to obesity, trauma, age, and lifestyle changes is a major market driver. Spinal disorders account for a significant proportion of global musculoskeletal disease burden. According to the WHO, around 20% of the world's population is affected by spinal disorders annually. Get More Insights On This Topic:  Spinal Imaging Market

[alinladaru]

Enlife Solutions, partner of the SRNIR conference and organizer of the Vertebroplasty Workshop with Tecres (Italy) and Dr. Bogdan Dorobăț (SUUB)

[thedevilrisen]

Hospital - 2

Nova Crosby -

10:17 pm

Luke paced the hall outside the emergency room, the silence in the bustling hospital, unnerving. The only sounds emanating throughout the hall was his heavy footsteps and frantic breathing, erratic like his heart. Anyone passing by would be highly concerned, a young man in a distressed state however clamer then staring at Nova's emotionless face as she stayed in a half conscious state of mind.

He had received a message from Sidney saying he was boarding the plane roughly twenty minutes ago, there hadn't been much update from the doctors on Nova's state as they were currently trying to figure out what's wrong and what the best course of treatment would be.

Luke was roughly on his thirtieth lap down the hall when a door crashes open and a nurse is navy scrubs peered out, when she spotted his pacing figure she moved towards him, calling out gently.

"Are you here for Nova Crosby?" she spoke quietly, hands clasping in front of her. The nurse stood like a pylon in the storm of Luke's emotions as he whipped around and practically sprinted to her, after hearing nothing for the first forty minutes of being in the hospital Luke was becoming understandably desperate.

Anticipating the barrage of questions the nurse tenderly grasped his arm and led him to a small cluster of seats adoring the side of the hall, non-verbally asking him to take a seat. News about any loved on becoming injured and hospitalised is always hard to deal with. Luke tried and failed to form words but no words from any of the 7,000 dialects of the world would accurately depict his feelings.

"Take you're time son." she murmured grazing her hand feather-lightly over the fabric of his hoodie. Luke choked out a wet, unintelligible sound before taking another few gasping breaths desperately trying to tame his mind but it felt akin to herding cats.

"H-how is she." he formed eventually, lips feeling swollen around the words. His brain was still struggling to even comprehend the fact that this situation was real, that Nova was in the emergency department with critical injuries and all he could do is watch and wait for his Nova to come back to him.

"She's going to alright.. eventually." the nurse stated, "I'm not going to sugar coat it. She has a long road ahead of her and will need lots of support but right now they are preparing for surgery to place some disk in her back to counteract the vertebrate discs from deflating."

Luke took a deep breath, "Something tells me that won't be it."

The nurse sighed, the smile lines on her face showing the many happy moments and information she would have shared but now it only sported a frown, "She has a minor concussion, however that is the least of your worries, she also has a fractured sternum but there is little we can do about that." She let out a long sigh, "We will need to keep her under monitoring though at risk of a collapsed lung."

Luke picked at the skin around his finger, taking a deep breath. "That's a lot."

The nurse smiled softly, "It could however be much, much worse too hon." she watched as Luke contemplated this notion, grappling once again with his mind before he nodded reluctantly.

"I think you should take a walk, hon. Go down to the cafe on level two, they do a wonderful banana bread." the nurse smiled gently, standing up and guiding Luke with her.

"I will, you have my phone number, her father's too but he is on a plane here currently so please, call me if anything changes." Luke begged, eyes wide and voice shaky.

"I will hon, I will personally make sure." She smiled gently, "Now go eat! Banana bread remember!"

Luke nodded to her grateful for the support in this treacherous time, as the doors to the elevator opened and he stepped in his phone buzzed.

Sidney - 11:02 I've landed, what's new? I'll be there in half an hour.

[slamdunktheories]

What sort of injury did Sakuragi have? An orthopaedic surgeon weighs in

Hey, gang! I stumbled upon this interesting article sometime back and have been meaning to share it. It's basically an orthopaedic surgeon (and fellow SD fan) analysing what sort of back injury Sakuragi had gotten during the Sannoh match. See article here (in Japanese). Google-translated English version is here.

In short, the surgeon thinks it was either a vertebral body fracture or a lumbar transverse process fracture, and goes on to talk about the recovery period one could expect from such an injury, how the team reacted to it in the story, etc.

His response when asked how Anzai-sensei and Ayako had handled things was pretty funny. “From the POV of an orthopaedic surgeon, it was of course a total fail.” LMAO!

But then he goes on to say something that would probably resonate with every SD fan (that if they had done the right thing and benched Sakuragi... there’d be no story).

As a fan, I'm relieved to hear that the injury seems perfectly realistic and also perfectly recoverable. Thank you Inoue-sensei for sticking to realism even in key/dramatic moments.

Have a gander at the article - it's quite interesting and much more in-depth than what I've shared here! Again, links here:

Original article here (in Japanese). Google-translated English version is here.

[breathing-rapture]

Spine spin!!! Spin spine!!!

Everyone ignore the sacrum being offset, I didn’t notice until I rewatched the recording. It’s hard to get each vertebra to stay lined up…

Anyways this is the spine of that coyote car-hit-survivor, with the fractured and refused femur and humerus… she’s got some strangely healed ribs too, aaand a few fused vertebrae in the spine!!! I tried to get a close up here, but it’s really hard to appreciate on film… the bones developed this weird shell, one of the vertebral bodies was shattered to nothing and was anchored to the other by the sliver of body it had left. The whole mass would’ve limited her mobility I imagine. It’s a miracle she survived long enough for the bones to heal so thoroughly.

[vaporwavedoggie]

Ahahahah I should probably explain why I'm not on here as much atm, along with most of my other social media.

It's gonna be long but I know I have some folks on here worried about me so I'll put everything under the cut.

Alright buckle up, this will get long.

To shorten things, my chronic pain is significantly getting worse very quickly, along with heart issues.

Not to mention my shit mental health.

But here's the long story:

There's something up with my heart. I don't know exactly what the diagnosis will be, I have a few more tests including a fun little holter monitor placement or whatever it's called.

It's where I wear this monitor over my heart for a few days and press a button whenever I start having flareups. My flareups consist of my blood pressure suddenly dropping very low (I think the lowest it was clocked was somewhere in the 80s/60s range if I remember correctly), headaches, bad chest pain, limb weakness/numbness, sudden exhaustion/passing out, etc.

They did an echo on my heart but the results didn't tell me much other than I have a dialated left atrium. No idea what that means, don't know if it's even related to the shit going on with me. I won't find out until the other tests are done and looked over.

I'm going as far as to try and give up cigarettes for the time being for this. My doc gave me a ton of nicotine patches, so I'm really hoping those will help with the urges. I'm going to be going from smoking about half a pack or so a day to patches that are 7mg of nic, so uhhh yeah.

Another reason why I'm distancing myself from online spaces more other than my personal discord servers is because stressful stuff, discourse, all that makes my flareups much much worse. I'm doing it not to be a bitch, but for my own health. So for a bit I'll probably only post art I occasionally draw n what not.

Now on to the other issues. My lower back keeps me in damn near constant chronic pain. They did an xray on it, and my MyChart (fun little doctor app) said this about their findings:

"Vertebral body heights and alignment are well-maintained. No fracture or subluxation. Pedicles are intact. Mild loss of disc height at L5-S1."

I'm not entirely sure if that's anything important, again, I go to my pcp about it in the beginning of October since there's a few more issues they'd like to test me for before coming to a diagnosis and treating me.

As for my back pain though, it's to the point where it's nearly disabling me physically.

I've had it for many years. Idk exactly when it all started, but I really started noticing it around the time I was 19-20. I have a theory it's because one of my first jobs that I worked for about a year was at a warehouse. It was very physical labor.

I'd be lifting heavy boxes constantly to the point where when I got home I couldn't bend down from the pain. I'd just have to flop down on my bed and pass out. And this went on about 4 days a week for a year.

At first, it started off as a small patch on my lower back, at the base of my spine, not being able to be touched. The gentlest poke would feel like stabbing pain. And it only got worse over the years, with the area spreading.

Now it's to the point where I can't stand for long, and when I sit or lay down I have to shift my position every 10-20 minutes or it flares up. And I dread going to sleep for a number of reasons. Not just because of the night terrors I have damn near every night due to my CPTSD, but because I wake up in excruciating pain most of the time due to not being able to shift my body in my sleep.

Worst part is, when I sleep, I'm dead to the world. If the night terrors aren't too horrible that night, I'm like a rock. No one can move me. Lord knows my husband has tried. And I'll sleep for about 12-20+ hours at a time at this point.

Funny thing is? No matter how much sleep I get, even if I get the base recommended amount without under or over sleeping, I'm ALWAYS exhausted.

My doc has sent a referral for me to get a sleep study but they have yet to reach out to me. I suspect this may also contribute to my heart issues but idk for sure.

So yeah. It's not enough that I deal with shitty mental health issues on a constant, but also chronic physical health issues as well.

Worst part is my family is borderline poverty. Despite everything I'm STILL trying to get a job because my family needs the money, along with others in the house, including my oldest son and teenage son.

Yet for whatever reason, everyone claims they're hiring, yet won't hire any of us. For me, I understand. I always struggled to keep a job due to various issues. But my sons have a completely clean slate, and my roomie has a great resume with plenty of long history, yet no one will hire anyone. Not even McDonald's.

People act like it's all us. We try everything we can, from dressing up in our nicest clothes for the interview, following up with the job, being friendly, giving the interviewer our skills. Worst part is they act like they're fucking impressed, then turn around and claim they've decided to go with someone more qualified for the position, or they're not hiring anymore.

Yes, I know I'll hurt myself if I try working a job and pushing myself beyond my limits every day, but it's taking too damn long for disability to do shit. Disability is very hard to get in Texas for whatever reason and God it's stupid. It usually takes a minimum of 2-3 years for most, and we don't have that time.

The price of rent, groceries, and everything else keeps skyrocketing, yet my roomies won't get a raise on their disability, my husband won't get a raise on his job other than just a few cents once a year.

We're living by the skin of our teeth. Paycheck to paycheck. Most of our food comes from various food banks in the area we make multiple trips to a week.

Then when it comes to my mental health issues, I'm handling it the best that I possibly can.

My CPTSD has been flaring up. Then there's the other shit going on with my head I won't get into.

I'm nearly constantly haunted by trauma and I'm so fucking tired of it. I have to keep myself busy or it creeps into my mind. And I have somnophobia because every time I sleep I'm almost guaranteed to have a night terror. No, prasosin won't help.

Anyways that's a small portion of the shit im going through and why I probably won't be online much until I get shit sorted out.

Is it weird to be the happiest you've ever been in your life, yet also the most miserable??

[remcocoa]

vertebral fractures for nicolas debeaumarché, but that was a really scary crash so good to hear an update.

[humanransome-note]

Thinking about TLOU infected biology because it’s fuck all AM and I can’t sleep.

They should all have broken/poorly healed limbs.

Like I know why they don’t, in the game and the show. (Game: because it came out in 2013 before we figured out cordyceps didn’t actually take over the brain. Show: because you can’t find and hire every appropriately hyper mobile individual on the planet)

So, the cordyceps fungus controls the necessary portions of the infected’s body for movement, and subsequent propagation. In the case of humans, this means limbs primarily, and mouth/throat secondarily.

I’d argue that in the front end of infection, you probably wouldn’t have people biting, but then again, insects infected by the cordyceps are often made to bite whatever plant they have been compelled to climb, as a more secure tether for when the fungus starts sprouting. But this is also the end of the infection, so a toss up.

Fungi mutate pretty quickly though (especially compared to vertebrates) so Tess being forced to open her mouth by the fungus at the end of the episode could easily be explained away by mutations over time, as well as where her infection began.

But! Back to broken limbs. What we know now about cordyceps, is that they do not invade and take control of the brain, they in fact do not commingle with the nervous system at all. (So I gotta go back and amend that TikTok I made cause it’s very wrong now but I doubt anyone besides me cares.)

Cordyceps invade muscle tissue, and there are actually studies trying to figure out if they can help with things like muscular atrophy and weakness because they are thought to increase the body’s production of ATP (cellular energy) in those areas. (Extremely simplified, not a biologist, just a weirdo who can’t sleep rn) Anecdotally Cordyceps can help with muscle growth and repair, immunity to some forms of cancer, and *cough* performance, in those suffering with ED.

I’m off track again! Anyway! With all this information and it being 2:15 am I have come to the sleepless conclusion that a better analogy for TLOU infected internals would be more akin to a secondary nervous system, controlled solely by the fungus.

Now, you may be asking “if it’s like two nervous systems, why can’t the person fight it?” Well I’m glad you asked that voice that feels like it belongs to a Janet.

Because the human brain is a wonderful, complex, convoluted thing. Like a pile of tapioca in a bowl of soy sauce with some sautéed batteries, piloting a mech suit made of meat.

You can break your own bones.

Theoretically.

Or actually if you’ve got the gumption or just general lack of hand eye coordination and a shitty inner ear.

But most of the time, it’s theoretically, because your brain stops you from breaking them. Your muscles, even if you don’t work out, are capable of producing enough force to tear themselves from the bone, if not just break the bone while they’re at it. Your brain, the genius that it is, goes ‘ya know what? How about I put a cap on that’ and prevents you from producing that much force.

There have been recorded instances though of “hysterical strength” where people have just lifted entire cars, torn a car door off the hinges, there was even one where a kid lifted the car off his younger brother, cracked at least three teeth from how hard he was gritting them. Think Deku’s quirk from the first few seasons of MHA. All of these people lived, all of them fractured something.

We can’t replicate it in controlled setting because the current theory for why in part that it happens has something to do with shock, and putting someone in shock is unethical. It would be cool to know how it works, sure, but I don’t see any real point for trying to figure it out.

But back to the mold, cordyceps don’t have that limiter, it wouldn’t even have a concept for something like that, it’d just go!

This also goes with another thought I had about how the infected should be either missing a lot of teeth or have chipped teeth. The human reflex is to protect our heads and faces when we fall, fungus don’t care, fungus doesn’t have teeth, fungus doesn’t even know what teeth ARE.

“The person is still conscious during all this?”

… YEP!

Unfortunately, as long as higher brain functions are still capable of functioning, then there is a non zero chance that the person is helpless and aware.

The common consensus for a person living without water is three days, without food roughly three weeks. These are generalizations but they also need to be considered when talking about the progression of the infection.

The food I sort of rigged an idea for, that being the initial fungal blooms occur in the stomach and GI tract, the fungus eats the body, the body eats the fungus. This can’t last forever, because that would be a perpetual machine and that would completely obliterate the laws of thermodynamics, but it could keep a person going, that and the body naturally breaking down fat and muscle tissue for energy.

The water is a bit trickier though, the fungus is definitely the primary receiver and source of water for the body. Humid climates would be hell for a multitude of reasons.

But these issues are also somewhat mitigated by the fact that most infected aren’t ‘actively’ hunting. More often than not they’re in a dormant state until an external stimuli brings them to attention. (Usually sound) and while humans don’t hibernate, sleeping/keeping still can have lesser but similar effects on the metabolism.

Which means patrols were probably more for bandits/raids/smugglers than for roaming infected.

Ellie’s immunity.

It does, in part, have to do with the fact her mother was infected while pregnant. No doubts about that. But genuine immunity? Like actual full on she can’t catch it? No. Because she already has it.

Asymptomatic carrier was my first (and still is) my preferred explanation for this. The electronic scanner caught it, but the dogs didn’t. Why?

Because dogs aren’t trained to sniff out the fungus itself, what they’re smelling are the body’s attempts at an immune response, which is usually fine because antibodies in this sense mean definitely infected. But since Ellie is asymptomatic, it means her body isn’t producing an immune response at all.

Could she give it to someone else? In both the game and show, no. Because she is an asymptomatic carrier, she has actually grown a mutualistic relationship with the fungus, and I’m assuming, like tomatoes, if the fungus doesn’t see a need to propagate (IE all biological needs are met) it won’t try to reproduce.

If she were starved though? Like full on, the hunger pangs have come and gone, massive brain fog, her fingers are looking a lot like carrot sticks rn. Then the fungus might start being aggressive and turn her.

Whatever that may be, the Fireflies digging around her noggin without even a FUCKING MRI was stupid no matter what and on god I know it’s the apocalypse but they don’t even check if her lymph nodes were swollen, or if her reflexes are unusual!

An actual living specimen that as far as anyone knows has had the fungus rocking around in their brain stem for 14 odd years and no one wants to check if she had say… faster healing? Strengthened immune system? Increased/decreased metabolism!

THERE IS SO MUCH SHIT THAT COULDVE BEEN EFFECTED BECAUSE SHES GOT FUNGUS ALL UP IN HER MUSCLE TISSUE!!!! AND NO ONE WAS WILLING TO PUT THE “CURE” ON HOLD AND TRY TO DOCUMENT ACTUAL IDENTIFIABLE DATA!!!!

JESUS CHRIST!!!! EVERY SINGLE MF IN SCRUBS SHREAD YOUR DIPLOMA!! I DONT CARE IF YOUR NAN MADE IT FOR YOU WHEN YOU SHOULDVE GRADUATED YOU DONT DESERVE EVEN THAT!!!

[sassenach77yle]

Here, Dr. Randall.” Joe leaned over and carefully placed the skull in my hands. “Tell me whether this lady was in good health, while I check her legs.” “Me? I’m not a forensic scientist.” Still, I glanced automatically down. It was either an old specimen, or had been weathered extensively; the bone was smooth, with a gloss that fresh specimens never had, stained and discolored by the leaching of pigments from the earth. “Oh, all right.” I turned the skull slowly in my hands, watching the bones, naming them each in my mind as I saw them. The smooth arch of the parietals, fused to the declivity of the temporal, with the small ridge where the jaw muscle originated, the jutting projection that meshed itself with the maxillary into the graceful curve of the squamosal arch. She had had lovely cheekbones, high and broad. The upper jaw had most of its teeth—straight and white. Deep eyes. The scooped bone at the back of the orbits was dark with shadow; even by tilting the skull to the side, I couldn’t get light to illuminate the whole cavity. The skull felt light in my hands, the bone fragile. I stroked her brow and my hand ran upward, and down behind the occiput, my fingers seeking the dark hole at the base, the foremen magnum, where all the messages of the nervous system pass to and from the busy brain. Then I held it close against my stomach, eyes closed, and felt the shifting sadness, filling the cavity of the skull like running water. And an odd faint sense—of surprise?

“Someone killed her,” I said. “She didn’t want to die.”

I opened my eyes to find Horace Thompson staring at me, his own eyes wide in his round, pale face. I handed him the skull, very gingerly. “Where did you find her?” I asked. Mr. Thompson exchanged glances with Joe, then looked back at me, both eyebrows still high.

“She’s from a cave in the Caribbean,” he said. “There were a lot of artifacts with her. We think she’s maybe between a hundred-fifty and two hundred years old.”

“She’s what?” Joe was grinning broadly, enjoying his joke. “Our friend Mr. Thompson here is from the anthropology department at Harvard,” he said. “His friend Wicklow knows me; asked me would I have a look at this skeleton, to tell them what I could about it.” “The nerve of you!” I said indignantly. “I thought she was some unidentified body the coroner’s office dragged in.” “Well, she’s unidentified,” Joe pointed out. “And certainly liable to stay that way.”[...]

“Oh, de headbone connected to de…neckbone,” Joe sang softly, laying out the vertebrae along the edge of the desk. His stubby fingers darted skillfully among the bones, nudging them into alignment. “De neckbone connected to de…backbone…” “Don’t pay any attention to him,” I told Horace. “You’ll just encourage him.” “Now hear…de word…of de Lawd!” he finished triumphantly. “Jesus Christ, L. J., you’re somethin’ else! Look here.” Horace Thompson and I bent obediently over the line of spiky vertebral bones. The wide body of the axis had a deep gouge; the posterior zygapophysis had broken clean off, and the fracture plane went completely through the centrum of the bone. “A broken neck?” Thompson asked, peering interestedly. “Yeah, but more than that, I think.” Joe’s finger moved over the line of the fracture plane.

“See here? The bone’s not just cracked, it’s gone right there. Somebody tried to cut this lady’s head clean off. With a dull blade,” he concluded with relish.

Horace Thompson was looking at me queerly. “How did you know she’d been killed, Dr. Randall?” he asked. I could feel the blood rising in my face. “I don’t know,” I said. “I—she—felt like it, that’s all.” “Really?” He blinked a few times, but didn’t press me further. “How odd.” “She does it all the time,” Joe informed him, squinting at the femur he was measuring with a pair of calipers. “Mostly on live people, though. Best diagnostician I ever saw.” He set down the calipers and picked up a small plastic ruler. “A cave, you said?” “We think it was a…er, secret slave burial,” Mr. Thompson explained, blushing, and I suddenly realized why he had seemed so abashed when he realized which of us was the Dr. Abernathy he had been sent to see. Joe shot him a sudden sharp glance, but then bent back to his work. He kept humming “Dem Dry Bones” faintly to himself as he measured the pelvic inlet, then went back to the legs, this time concentrating on the tibia. Finally he straightened up, shaking his head. “Not a slave,” he said. Horace blinked. “But she must have been,” he said. “The things we found with her…a clear African influence…” “No,” Joe said flatly. He tapped the long femur, where it rested on his desk. His fingernail clicked on the dry bone. “She wasn’t black.” “You can tell that? From bones?” Horace Thompson was visibly agitated. “But I thought—that paper by Jensen, I mean—theories about racial physical differences—largely exploded—” He blushed scarlet, unable to finish. “Oh, they’re there,” said Joe, very dryly indeed. “If you want to think blacks and whites are equal under the skin, be my guest, but it ain’t scientifically so.” He turned and pulled a book from the shelf behind him. Tables of Skeletal Variance, the title read. “Take a look at this,” Joe invited. “You can see the differences in a lot of bones, but especially in the leg bones. Blacks have a completely different femur-to-tibia ratio than whites do. And that lady”—he pointed to the skeleton on his desk—“was white. Caucasian. No question about it.”

Cap 20 diagnosis ~VOYAGER

[pathologising]

why my grandfather has a 25% vertebral fracture can we stop the aging process PLEAAAASE I can't do this rn

[mcatmemoranda]

Lifestyle measures – Lifestyle measures to reduce bone loss include adequate calcium and vitamin D intake, exercise, smoking cessation, fall prevention, and avoidance of heavy alcohol use. In general, women should achieve 1200 mg of elemental calcium daily (total diet plus supplement) and 800 international units of vitamin D daily. If dietary calcium intake is inadequate, we suggest calcium supplementation.

●Low bone mass (osteopenia) – In postmenopausal women with low bone mass and without fragility fracture, we calculate absolute fracture risk using the Fracture Risk Assessment Tool (FRAX). For most patients with low to moderate fracture risk, we suggest not using pharmacologic therapy to prevent bone loss or fracture. (See 'Our approach' above.)

●Patient selection for osteoporosis pharmacologic therapy

•For postmenopausal women with a diagnosis of osteoporosis based on bone mineral density (BMD; T-score ≤-2.5) or fragility fracture, we recommend treatment with pharmacotherapy (algorithm 1) (Grade 1A).

•For postmenopausal women with low BMD (T-score between -1.0 and -2.5) and high fracture risk, we also suggest pharmacologic therapy (Grade 2B). In the United States, a 10-year probability of hip fracture or combined major osteoporotic fracture of ≥3 or ≥20 percent, respectively, is a reasonable threshold for pharmacotherapy.

●Choice of initial therapy

•Most women with osteoporosis – For the initial treatment of osteoporosis in most postmenopausal women, we suggest oral bisphosphonates (algorithm 2) (Grade 2B). We prefer these agents based on efficacy, cost, and long-term safety data. Oral bisphosphonates are contraindicated in those with esophageal disorders (eg, esophageal stricture) or known malabsorption (eg, Roux-en-Y gastric bypass) (algorithm 2).

Algorithm 2:

25(OH)D: 25-hydroxyvitamin D; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; GI: gastrointestinal.

* Refer to additional UpToDate content on evaluation of hypercalcemia and hypocalcemia.

¶ Very high risk of fracture: No consensus exists on the definition of very high fracture risk. Examples may include: T-score of ≤–3.0 even in the absence of fractures, T-score of ≤–2.5 plus a fragility fracture, severe or multiple vertebral fractures.

Δ Patients most likely to benefit from anabolic therapy are those with the highest risk of fracture (eg, T-score ≤–3.5 with fragility fracture[s], T-score ≤–4.0, recent major osteoporotic fracture, or multiple recent fractures).

◊ Increased risk of vertebral fracture is evident after discontinuation of denosumab; the need for indefinite administration of denosumab should be discussed with patients prior to its initiation.

§ Anabolic agents include teriparatide, abaloparatide, romosozumab.

¥ Oral bisphosphonates are poorly absorbed and must be taken on an empty stomach first thing in the morning with at least 240 mL (8 oz) of water. After administration, the patient should not have food, drink, medications, or supplements and should remain upright for at least 1 half-hour.‡ Denosumab is an alternative to intravenous zoledronic acid for women at high risk for fracture who have difficulty with the dosing requirements of oral bisphosphonates or who prefer to avoid intravenous bisphosphonates due to side effects. However, increased risk of vertebral fracture is evident after discontinuation of denosumab so the need for either indefinite treatment or transition to another osteoporosis medication should be addressed with patients before denosumab initiation.

We typically prefer alendronate as our choice of oral bisphosphonate due to efficacy in reducing vertebral and hip fracture and evidence showing residual fracture benefit after a five-year course of therapy is completed. Risedronate is a reasonable alternative.

•Very high fracture risk – For postmenopausal women with very high fracture risk (eg, T-score of ≤-2.5 plus a fragility fracture, T-score of ≤-3.0 in the absence of fragility fracture[s], history of severe or multiple fractures) (algorithm 1), we suggest initial treatment with an anabolic agent (Grade 2B). Patients most likely to benefit from anabolic therapy are those with the highest risk of fracture (eg, T-score ≤-3.5 with fragility fracture[s], T-score ≤-4.0, recent major osteoporotic fracture, or multiple recent fractures). Options for anabolic therapy include teriparatide, abaloparatide, or romosozumab. For patients with very high fracture risk who cannot be treated with an anabolic agent due to cost, inconvenience, contraindications, or personal preference, a bisphosphonate or denosumab may be appropriate (algorithm 2). Patients should be under the care of a provider with expertise in treating osteoporosis to facilitate shared decision-making.

●Contraindications to bisphosphonates

•Oral bisphosphonates contraindicated – Patients who cannot take oral bisphosphonates can be treated with an intravenous (IV) bisphosphonate instead (algorithm 2). Zoledronic acid is our agent of choice, as it is the only IV bisphosphonate with demonstrated efficacy for fracture prevention. Denosumab is a reasonable alternative. (See 'Gastrointestinal malabsorption or difficulty with dosing requirements' above.)

●Oral and IV bisphosphonates contraindicated

•Most women with osteoporosis – For most patients who cannot tolerate any bisphosphonate, we suggest denosumab rather than an anabolic agent (Grade 2C). Increased risk of vertebral fracture develops after discontinuation of denosumab, so the need for indefinite administration should be discussed with patients prior to denosumab initiation.

Anabolic agents may be used in patients with less severe osteoporosis when bisphosphonates are contraindicated. For patients with no history of fragility fracture(s), particularly those at high risk for breast cancer, raloxifene is a reasonable alternative.

•Very high fracture risk – For patients at very high risk of fracture (eg, T-score of ≤-2.5 plus a fragility fracture, T-score of ≤-3.0 in the absence of fragility fracture(s), history of severe or multiple fractures) who were not treated initially with anabolic therapy, we suggest switching to an anabolic agent (Grade 2C). Denosumab is an alternative. (See 'Contraindications or intolerance to any bisphosphonates' above and "Parathyroid hormone/parathyroid hormone-related protein analog therapy for osteoporosis", section on 'Overview of approach'.)

After initial therapy with an anabolic agent is discontinued, patients should be treated with an antiresorptive agent (typically a bisphosphonate) to preserve the gains in BMD from anabolic therapy. For individuals who are unable to tolerate oral or intravenous bisphosphonates, alternatives may include denosumab or raloxifene. (See "Parathyroid hormone/parathyroid hormone-related protein analog therapy for osteoporosis", section on 'Management after teriparatide' and "Parathyroid hormone/parathyroid hormone-related protein analog therapy for osteoporosis", section on 'Management after abaloparatide'.)

●Monitoring – For patients who initiate osteoporosis pharmacotherapy, we obtain a follow-up dual-energy x-ray absorptiometry (DXA) of the hip and spine after one to two years (algorithm 3). A change in BMD is considered significant only if it exceeds the least significant change (LSC) for the specific densitometer used. If LSC is not available, a threshold change of ≥5 percent has been suggested as an alternative. (See 'Our approach' above.)

•Bone mineral density stable or increased – If BMD is stable or improved, we continue therapy and remeasure BMD less frequently (eg, two to five years based on the clinical setting).

•Bone mineral density decreased or fracture during therapy – After at least one year of osteoporosis pharmacotherapy, a BMD decrease greater than the LSC or new fragility fracture should trigger additional evaluation, including assessment for treatment nonadherence or interim development of a secondary cause of bone loss (table 8). Whenever possible, patients should be under the care of a clinician with expertise in osteoporosis management.

If a remediable secondary cause of bone loss is identified, it should be treated. If the secondary cause of bone loss cannot be mitigated, or no secondary cause is identified, management depends on BMD and whether an interim fragility fracture occurred.

-Interim fragility fracture or T-score ≤-2.5 – For postmenopausal women who experience a fragility fracture or have a T-score ≤-2.5 on bisphosphonate therapy, we suggest discontinuing the bisphosphonate and switching to anabolic therapy (Grade 2C). Teriparatide and romosozumab increase BMD after previous bisphosphonate treatment. (See 'Interim fragility fracture or T-score ≤-2.5' above and 'Selection of anabolic agent' above.)

-BMD decreased but no interim fracture and T-score >-2.5 – In the absence of interim fragility fracture or T-score ≤-2.5, we use bone turnover markers and clinical assessments to evaluate the likelihood of treatment effectiveness. If treatment is unlikely effective, we stop the oral bisphosphonate and switch to IV zoledronic acid. If treatment is likely effective, we typically continue oral bisphosphonate therapy and remeasure BMD with DXA in one to two years. (See 'BMD decreased but no interim fracture and T-score >-2.5' above.)

[rjzimmerman]

Excerpt from this story from National Geographic:

Orcas continue to dominate headlines, and for good reason—the ultimate ocean predators keep finding ways to surprise us.

These versatile dolphins (yes, they’re not whales) are likely the most widely distributed vertebrate on the planet, living from the polar regions south to the Equator. Orcas have very diverse diets, feasting on fish, penguins, and marine mammals such as seals, sea lions, and even whales—and they’ve developed ingenious methods for procuring their prey.

Some Antarctic orcas work as a team to create waves that knock seals off floating ice sheets. Others have figured out how to extract livers from great white sharks—sometimes solo, and in as little as a few minutes.

1. Rogue orcas are thriving on the high seas—and they’re eating big whales

In March 2024, scientists reported a brand-new population of killer whales: Animals that ply the high seas, hunting large whales and other enormous prey. These open-ocean denizens have been spotted at numerous locations far from Oregon and California, many of them well beyond the continental shelf, where waters can reach depths of 15,000 feet,according to the study in Aquatic Mammals. This potentially new population feasts on sizable prey, such as sperm whales, elephant seals, and dolphins.

2. These orcas control the waves to hunt

In one region of Antarctica, about a hundred orcas have mastered a hunting technique called wave washing. The secret: working together to turn water into a weapon. The orcas, having identified their target, form a battle line and start charging toward the seal atop an ice floe. Just before reaching it, they rotate to their sides in a single, synchronized motion and plunge underwater. The momentum creates a wave so powerful that it floods the ice sheet, cracking the surface and whipping the flailing seal around. Slowly and methodically, they repeat the charge. The ice fractures more.

3. Single orca kills great white shark

An orca already famous for surgically extracting shark livers has a new trick up its sleeve: Killing one of nature’s most deadly predators all by himself. For the first time ever, scientists documented an orca taking down a great white shark solo in March 2024. The new footage, taken in June 2023 in Mossel Bay, shows an orca known as Starboard killing a juvenile eight-foot-long great white shark and removing its liver—all in under two minutes. The orca then parades past the videographer's boat with the bloody liver in its mouth.

4. Fish-eating orcas kill porpoises—for fun?

In 2005, Deborah Giles saw something she’ll never forget—a dead porpoise, riding the snouts of a pod of orcas off Washington State. “What on Earth is happening?” wondered Giles, the science and research director for the nonprofit Wild Orca, based in Friday Harbor. “It didn't make any sense.” Scientists first recorded this behavior in southern resident killer whales in 1962, and since then, eyewitnesses have observed more than 70 such incidents, peaking in 2005 at 10.

5. Orcas are working together to sink boats.

A population of orcas off the Iberian Peninsula has been gaining attention over the last three years—and causing angst among sailors—by attacking and even sinking boats in the area. The first recorded attack occurred in the Strait of Gibraltar in May 2020, with dozens of cases recorded since then. Most of the incidents are remarkably consistent, generally involving a small group of whales attacking the rudders of small sailboats before breaking off and swimming away. In June and November 2022, a pair of attacks caused two boats to sink; in May 2023, a badly damaged boat sank while it was being towed to shore.

[zerogate]

David Kallmes is an affiliated neuroradiologist at the renowned Mayo Clinic, whose headquarters are in Rochester, Minnesota. During the last two decades, Kallmes has performed many vertebroplasties. Conducted under continuous radiographic control, this surgical technique allows for the restoration of a vertebral fracture by injecting a type of bone “cement.” The cement is completely hard after a few hours, and twelve hours later, the patient can stand up. Vertebroplasty produces impressive results even when the wrong vertebra is accidentally filled with cement.

This peculiarity intrigued David Kallmes. Suspecting that other factors were responsible for the effectiveness of this medical procedure, he decided to conduct a study to determine if vertebroplasty was more effective than a placebo – a treatment that has no biological action but can be effective when the person receiving the placebo thinks they are receiving active treatment.

[...]

In this particular case, Dr. Kallmes and his colleagues developed a clinical trial in which some patients would receive true vertebroplasty while other patients would receive placebo surgery. To ensure that the 130 participating patients at the clinical trial could not know if they received the active treatment or the false treatment, they were prepared for their “operation” in the same way: they were brought into the operating room and then they were injected with an anesthetic agent in the back. Then a computer program randomly decided which patients would receive vertebroplasty or placebo. For both types of procedure, the doctors opened the container containing the bone cement, which gives off a strong smell akin to nail varnish solvent. Half of the patients received vertebroplasty, while the other half received the fake surgery. For the placebo patients, the doctors adhered to the following scenario: they pressed the patients’ backs and told them: “The cement is entering now, everything is fine, a few more minutes and everything will be over.”

Bonnie Anderson was one of the patients recruited for this clinical trial. She had a broken vertebra after a fall in her kitchen. Bonnie could hardly move due to the acute pain, and she could only walk by holding on to things. However, one week after the surgery, this 76-year-old woman could play golf again. What is remarkable in her case is that Bonnie received the fake surgery. The placebo procedure was also effective for several other patients who participated in this clinical trial. So effective that there was no statistically significant difference in terms of decreased pain relief and functional improvement between patients in both groups.

[...]

The research results indicate that the placebo effect is involved in all types of medical and psychological treatments. Thus, the meta-analyses – which are statistical analyses combining the results of several studies to more accurately assess the true magnitude of the phenomenon being studied (or “effect size”) – indicate that the placebo effect plays a crucial role in clinical trials for drugs targeting mood disorders such as major depression. In this regard, clinical researchers and psychologists Irving Kirsch and Guy Sapirstein examined the results of more than 19 clinical trials involving more than 2,000 patients. These researchers found that 75% of therapeutic outcomes are attributable to the placebo effect.

-- Mario Beauregard, Expanding Reality: The Emergence of Postmaterialist Science

[thedevilrisen]

nora could just got the wind knocked out of her and passed out maybe a mild concussion?

So, Nova's injuries range from 2 broken ribs, she narrowly escaped having deflated vertebrate disks. from landing on her stick she also fractured her sternum and then yes, a minor concussion.

[soniccrazygal]

Prolly the last things I'll share about the reincarnation Au before I start to get overwhelming with my oversharing

Michael and Terrence are the only fully immortal beings in the Au.

Michael because the Scooper injected him with around 5 litres of pure Remnant, and when OMC "put him back together," the Remnant became his blood

Terrence because he was part of Michael's soul since the start, so he was "infected" with his twin's Remnant. He was also a Soul for almost his entire existence, so he retains a big part of his abilities

When OMC rebuilt Michael's body, he noticed that many of Ennard's parts were still inside Michael's body. He tried to take them out but quickly found out that he accidentally fused them with Michael's flesh, so he couldn't do anything. Now some of Michael's organs are patched up with metal (lunggs, intestines and heart) or straight-up made of metal (liver, small intestine and kidneys), and some of his bones (mainly his ribcage and vertebrates) are made of metal. This gives him many pros (enhanced stamina and strength, he's less prone to fractures or organ failures), but he's also more vulnerable to electricity, so a strong teaser can be dangerous for him.

♪Lullaby_⁜_Anon♪

Got to watch out for those controlled shocks.