title: Fractures and handicap in an adult population: A clinical study.
abstract: OBJECTIVE
  To evaluate the bone status of ambulatory patients with physical and mental handicaps before a program of fracture prevention.
  
  
  METHODS
  We recruited 58 walking adults. We retrospectively collected the past episodes of fractures, essentially peripheral, and epilepsy. The serum calcium, albumin, 25-hydroxyvitamin D, parathormone, CTX-1 and P1NP levels were prospectively measured in 36 consecutive patients. Each patient received daily calcium and vitamin D. The vertebral status has been not evaluated.
  
  
  RESULTS
  Twenty-one patients had presented at least one fracture. Thirty nine per cent of the fractures were minor (nasal bone, hands, feet). The age of patients with fractures was significantly higher than patients without fracture (46 versus 40years, respectively; p=0.04). Patients with fractures had a significantly increased S-P1NP (63.5ng/ml+/-32.0 versus 41.9ng/ml+/-20.0, respectively; p=0.02). Nineteen patients suffered from epilepsy. We listed 23 fractures among 9 patients treated by phenobarbital and 8 fractures, which tended to be less severe among 5 patients epileptics without this drug. Minor fracture was often followed by severe fracture in case of phenobarbital treatment. This treatment was associated with a significantly lower serum calcium level (2.16mmol/l+/-0.05, versus epileptic patients without phenobarbital 2.32mmol/l+/-0.08, p<0.0004).
  
  
  CONCLUSIONS
  The presence of a fracture, even minor, must encourage to improve the preventive and curative measures among patients with handicaps.
authors.affiliation: Medicine Department, Valence Hospital, 179 boulevard Maréchal Juin, 26000 Valence Cedex 09, France. guillaume.chevrel@wanadoo.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Chevrel
authors.forename: Anne
authors.initials: A
authors.lastname: Limouzin
authors.forename: Patrick
authors.initials: P
authors.lastname: Garnero
authors.forename: Caroline
authors.initials: C
authors.lastname: de Montalivet
authors.forename: Dominique
authors.initials: D
authors.lastname: Loubier
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D024042:Collagen Type I / Q000097:blood; D015897:Comorbidity; D006233:Persons with Disabilities; D004827:Epilepsy / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D010634:Phenobarbital / Q000627:therapeutic use; D011347:Procollagen / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; D012709:Serum Albumin; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium; D010634:Phenobarbital