Fracture rates lower in rural than urban communities : the Geelong Osteoporosis Study

Background: Urban and rural communities differ in the incidence of several diseases including coronary heart disease and some cancers. Lower hip fracture rates among rural than urban populations have been reported but few studies have compared rural and urban fractures at sites other than the hip.

Objective: To compare total and site specific fracture rates among adult residents of rural and urban communities within the same population.

Design and setting: This is a population based study on osteoporosis in Australia. All fractures occurring in adult residents over a two year period were ascertained using radiological reports. The rural and urban areas are in close proximity, with the same medical, hospital, and radiological facilities permitting uniform fracture ascertainment.

Main outcome measures: All fracture rates were age adjusted and sex adjusted to the Australian population according to the 1996 census of the Australian Bureau of Statistics and described as the rate per 10 000 person years. The p values refer to the adjusted rate difference.

Results: The hip fracture rate (incidence per 10 000 person years) was 32% lower (39 v 57, p<0.001), and the total fracture rate 15% lower (160 v 188, p=0.004) among rural than urban residents, respectively. The lower fracture rates in the rural population were also apparent for pelvic fractures.

Conclusion: In the older rural population, lower fracture rates at sites typically associated with osteoporosis suggest environmental factors may have a different impact on bone health in this community. If the national rate of hip fracture could be reduced to that of the rural population, the projected increase in hip fracture number attributable to aging of the population could be prevented.

Age- and gender-specific rate of fractures in Australia : a population-based study

There is little population-based data concerning fracture rates in Australia. We ascertained all fractures occurring during 2 years in adults aged 35 years and over residing within a defined region (population 218 000), representative of the Australian population. The major strength of this study is the comprehensive ascertainment of fractures, which was ensured by regular searches of the only two radiologic providers in the Geelong Osteoporosis Study region. Nevertheless, vertebral fractures are likely to be underestimated since our ascertainment relied on a clinical indication for a medical imaging procedure. Among those aged 35 – 55 years, the fracture rate (persons per 10 000/year) in men was about double the rate in women (65 vs 35). The fracture rate was almost 7 times higher in women over 60 years versus women less than 55 years of age. In contrast, the fracture rate in men over 60 years was only 50% higher than in men less than 55 years of age (72 vs 104). Fracture rates in women and men were highest at the hip (28 and 10 respectively), spine (21 and 7), distal forearm (Colles’) (18 and 4) and humerus (11 and 3), and were 3–4 times higher in women than men. These fractures accounted for 63% of all fractures in women and 32% in men. By contrast, the rate of lower leg and ankle fractures was less than 10 per 10 000 in both women and men and did not increase to the same extent with age. Hip fracture rates appear high, particularly among the older age strata, compared with retrospective ascertainment in other populations. In Australia, as in many other countries, there is an increasing longevity of the population. The number of women aged 90 years and over increased by 32% and the number of men of this age increased by 48% in the 5 years between the Australian national census of 1991 and 1996. Given stable fracture rates, the substantial health burden imposed by age-related fractures, particularly hip fractures, will continue to escalate in both women and men.

Skeletal morbidity among survivors of critical illness

Objectives: To describe the incident fracture rate in survivors of critical illness and to compare fracture risk with populationmatched control subjects.

Design: Retrospective longitudinal case– cohort study.

Setting: A tertiary adult intensive care unit in Australia. Patients: All patients ventilated admitted to intensive care and requiring mechanical ventilation for >48 hrs between January 1998 and December 2005.

Interventions: None.

Measurements and Main Results: New fractures were identified in the study population for the postintensive care unit period (intensive care unit discharge to January 2008). The incident fracture rate and age-adjusted fracture risk of the female intensive care unit population were compared with the general population adult females derived from the Geelong Osteoporosis Study. Over the 8-yr period, a total of 739 patients (258 women, 481 men) were identified. After a median follow-up of 3.7 yrs (interquartile range, 2.0–5.9 yrs) for women and 4.0 yrs (interquartile range, 2.1–6.1 yrs) for men, incident fracture rates (95% confidence interval) per 100 patient years were 3.84 (2.58 –5.09) for females 2.41 (1.73–3.09) for males. Compared with an age-matched random population-based sample of women, elderly women were at increased risk for sustaining an osteoporosisrelated fracture after critical illness (hazard ratio, 1.65; 95% confidence interval, 1.08 –2.52; p .02).

Conclusions: The increase in fracture risk observed in postintensive care unit older females suggests an association between critical illness and subsequent skeletal morbidity. The explanation for this association is not explored in this study and includes the effects of pre-existing patient factors and/or direct effects of critical illness. Prospective research evaluating risk factors, the relationship between critical illness and bone turnover, the extent and duration of bone loss, and the associated morbidity in this population is warranted.

Effect of the manufacturing process on the interlaminar fracture toughness of 2/2 twill weave fabric carbon/epoxy composites

A 2/2 twill weave fabric carbon fibre reinforced epoxy matrix composite MTM56/CF0300 was used to investigate the effect of different manufacturing processes on the interlaminar fracture toughness. Double cantilever beam tests were performed on composites manufactured by hot press, autoclave and 'Quickstep' processes. The 'Quickstep' process was recently developed in Perth, Western Australia for the manufacture of advanced composite components. The values of the mode I critical strain energy release rate (G1d were compared and the results showed that the composite specimens manufactured by the autoclave and the 'Quickstep' process had much higher interlaminar fracture toughness than the specimen produced by the hot press. When compared to specimens manufactured by the hot press, the interlaminar fracture toughness values of the Quickstep and autoclave samples were 38% and 49% higher respectively. The 'Quickstep' process produced composite specimens that had comparable interlaminar fracture toughness to autoclave manufactured composites. Scanning electron microscopy (SEM) was employed to study the topography of the mode I interlaminar fracture surface and dynamic mechanical analysis (DMA) was performed to investigate the fibre/matrix interphase. SEM micrography and DMA spectra indicated that autoclave and 'Quickstep' produced composites with stronger fibre/matrix adhesion than hot press.

Characterization and analysis of delamination fracture and nanocreep properties in carbon epoxy composites manufactured by different processes

Delamination resistance and nanocreep properties of 2/2 twill weave carbon epoxy composites manufactured by hot press, autoclave, and Quickstep^TM process are characterized and analyzed. Quickstep is a fluid filled, balanced pressure heated floating mold technology, which is recently developed in Perth, Western Australia for the manufacture of advanced composite components. Mode I and Mode II interlaminar fracture toughness tests, and nanoindentation creep tests on matrix materials show that the fast ramp rate of the Quickstep process provides mechanical properties comparable to that of autoclave at a lower cost for composite manufacturing. Low viscosity during ramping process and good fiber wetting are believed to be the reasons that this process produces composites with high delamination and creep-resistant properties. Nanocreep properties are analyzed using a Kelvin–Voigt model.

Manufacturing influence on the delamination fracture behavior of the T800H/3900-2 carbon fiber reinforced polymer composites

'Torayca' T800H/3900-2 is the first material qualified on Boeing Material Specification (BMS 8-276) which utilizes the thermoplastic-particulate interlayer toughening technology. Two manufacturing processes, the autoclave process and the fast heating rated Quickstep™ process, were employed to cure this material. The Quickstep process is a unique composite production technology which utilizes the fast heat transfer rate of fluid to heat and cure polymer composite components. The manufacturing influence on the mode I delamination fracture toughness of laminates was investigated by performing double cantilever beam tests. The composite specimens fabricated by two processes exhibited dissimilar delamination resistance curves (R-curves) under mode I loading. The initial value of fracture toughness GIC-INIT was 564 J/m2 for the autoclave specimens and 527 J/m2 for the Quickstep specimens. However, the average propagation fracture toughness GIC-PROP was 783 J/m2 for the Quickstep specimens, which was 2.6 times of that for the autoclave specimens. The mechanism of fracture occurred during delamination was studied under scanning electron microscope (SEM). Three types of fracture were observed: the interlayer fracture, the interface fracture, and the intralaminar fracture. These three types of fracture played different roles in affecting the delamination resistance curves during the crack growth. More fiber bridging was found in the process of delamination for the Quickstep specimens. Better fiber/matrix adhesion was found in the Quickstep specimens by conducting indentation-debond tests.

Experimental study on effect of loading rate on mode I delamination of z-pin reinforced laminates

This paper presents an experimental investigation on mode I delamination of z-pinned double-cantilever-beams (DCB) and associate z-pin bridging mechanisms. Tests were performed with three types of samples: big-pin with an areal density of 2%, small-pin with an areal density of 2% and small-pin with an areal density of 0.5%. The loading rates for each type of samples were set at 1 mm/min and 100 mm/min. Comparison of fracture load under different loading rates shows the rate effects on delamination crack opening and delamination growth. Optical micrographs of z-pins after pullout were also presented to identify the bridging mechanisms of z-pins under different loading rates.

The effect of cure cycle heating rate on the fibre/matrix interface

Development of civil aerospace composites is key to future “greener” aircraft. Aircraft manufacturers must improve efficiency of their product and manufacturing processes to remain viable. The aerospace industry is undergoing a materials revolution in the design and manufacture of composite airframes. The Airbus A350 and Boeing 787 (both due to enter service in the latter part of this decade) will push utilisation levels of  composite materials beyond 50% of the total airframe by weight. This  change requires massive investment in materials technology, manufacturing capability and skills development. The Quickstep process provides the ability to rapidly cure aerospace standard composite materials whilst providing enhanced mechanical properties. Utilising fluid to transfer heat to the   composite component during the curing process allows far higher heat rates than with conventional cure techniques. The rapid heat-up rates reduce the viscosity of the resin system greatly to provide a longer processing window introducing greater flexibility and removing the need for high pressure during cure. Interlaminar fracture toughness (Mode I) and Interfacial Shear Strength of aerospace standard materials cured using Quickstep have been    compared to autoclave cured laminates. Results suggest an improvement in fibre-matrix adhesion.

Study on thermoplastic-modified multifunctional epoxies : influence of heating rate on cure behaviour and phase separation

The effect of heating rate on the cure behaviour and phase separation of thermoplastic-modified epoxy systems was investigated. Polyethersulphone (PES) modified multifunctional epoxies, triglycidyl-aminophenol (TGAP) and tetraglycidyldiaminodiphenylmethane (TGDDM), as well T300/914 prepreg were used. It was shown that heating rate had a significant influence on the cure kinetics and phase structures of investigated systems. Greater heating rate causes higher epoxy conversion. The domain size of the macrophases formed from phase separation increases with the increase of heating rate. A more complete phase separation is achieved by fast heated thermoplastic-modified epoxy blends.

High strain rate tensile properties of rapidly cured woven carbon fibre composites

Tensile tests at high speeds corresponding to automotive crash events were conducted to understand the dynamic properties of rapidly cured woven carbon fiber composites. The High Strain Rate (HSR) experiments were conducted on a servo-hydraulic machine at constant velocities up to a maximum of 25 m/s (82 ft/s). Results from HSR tests were compared with the static results to determine the rate sensitivity of the composite. A high speed camera was used to capture the failure at HSR. The tensile properties of rapidly cured laminate were compared to oven cured laminate to justify its productivity while maintaining the desired properties. The methodology used to achieve constant velocity during HSR tests is discussed in detail. The specimen geometry was specially designed to suit the test rig and to achieve high speeds during tests. All the specimens failed with linear elasticity until sudden brittle fracture. The Scanning Electron Microscopy (SEM) images of the fracture zone were used to identify the failure modes observed at static and high strain rates.

Rheumatoid arthritis and incident fracture in women: a case-control study

Background:
To examine fracture incidence in women with rheumatoid arthritis (RA) for an entire geographical region of south-eastern Australia.

Methods:
Women aged 35 years and older, resident in the Barwon Statistical Division (BSD) and clinically diagnosed with RA 1994–2001 were eligible for inclusion as cases (n =1,008). The control population (n = 172,422) comprised the entire female BSD population aged 35 years and older, excluding those individuals identified as cases. Incident fractures were extracted from the prospective Geelong Osteoporosis Study Fracture Grid. We calculated rate ratios (RR) and 95% confidence intervals (CI) to compare the age- adjusted rate of fracture between the RA and non-RA populations, and used a chi-square test to compare proportions of fractures between women with and without RA, and a two-sided Mann–Whitney U-test to examine age-differences.

Results:
Among 1,008 women with RA, 19 (1.9%) sustained a fracture, compared to 1,981 fractures sustained by the 172,422 women without RA (1.2%). Fracture rates showed a trend for being greater among women diagnosed with RA (age-adjusted RR 1.43, 95%CI 0.98-2.09, p= 0.08). Women with RA sustained vertebral fractures at twice the expected frequency, whereas hip fractures were underrepresented in the RA population (p< 0.001). RA status was not associated with the likelihood of sustaining a fracture at sites adjacent to joints most commonly affected by RA (p= 0.22).

Conclusion:
Given that women with RA have a greater risk of fracture compared to women without RA, these patients may be a suitable target population for anti-resorptive agents; however, larger studies are warranted.

Investigating the predictive ability of gait speed and quadriceps strength for incident falls in community-dwelling older women at high risk of fracture

Gait speed is a recommended geriatric assessment of physical performance, but may not be regularly examined in clinical settings. We aimed to investigate whether quadriceps strength tests demonstrate similar predictive ability for incident falls as gait speed in older women. We investigated 135 female volunteers aged mean±SD 76.7±5.0 years (range 70-92) at high risk of fracture. Participants completed gait speed assessments using the GAITRite Electronic Walkway System, and quadriceps strength assessments using a hand-held dynamometer (HHD). Participants reported incident falls monthly for 3.7±1.2 years. N=99 (73%) participants fell 355 times during the follow-up period (mean fall rate 83 per 100 person years). We observed a reduced odds ratio for multiple falls (0.83, 95% CI 0.70-0.98) and a reduced hazard ratio for time to first fall (0.90, 95% CI 0.83-0.98), according to quadriceps strength. There was also a significantly shorter time to first fall for those with low quadriceps strength (<7.0 kg; lowest tertile) compared with those with normal quadriceps strength (estimated means [95% CI] 1.54 [1.02, 2.06] vs. 2.23 [1.82, 2.64] years; P=0.019), but not for those with low (<1.0 m/s) vs. normal gait speed (P=0.15). Quadriceps strength is a significant predictor of incident falls over three years amongst community-dwelling older women at high risk of fracture. Quadriceps strength tests may be an acceptable alternative to gait speed for geriatric assessments of falls risk.

Modeling of shear ductile fracture considering a changeable cut-off value for stress triaxiality

 A macroscopic ductile fracture criterion is proposed based on micro-mechanism analysis of nucleation, growth and shear coalescence of voids from experimental observation of fracture surfaces. The proposed ductile fracture model endows a changeable cut-off value for the stress triaxiality to represent effect of micro-structures, the Lode parameter, temperature, and strain rate on ductility of metals. The proposed model is used to construct fracture loci of AA 2024- T351. The constructed fracture loci are compared with experimental data covering wide stress triaxiality ranging between –0.5 and 1.0. The comparison suggests that the proposed model can provide a satisfactory prediction of ductile fracture for metals from compressive upsetting tests to plane strain tension with slanted fracture surfaces. Moreover, it is expected that the proposed model reasonably describes ductile fracture behavior in high velocity perforation simulation since a reasonable cut-off value for the stress triaxiality is coupled with the proposed ductile fracture criterion.

Investigation of hydraulic fracture propagation using a post-peak control system coupled with acoustic emission

This study investigates the fracture mechanism of fluid coupled with a solid resulting from hydraulic fracture. A new loading machine was designed to improve upon conventional laboratory hydraulic fracture testing and to provide a means of better understanding fracture behavior of solid media. Test specimens were made of cement mortar. An extensometer and acoustic emission (AE) monitoring system recorded the circumferential deformation and crack growth location/number during the test. To control the crack growth at the post-peak stage the input fluid rate can be adjusted automatically according to feedback from the extensometer. The complete stress-deformation curve, including pre- and post-peak stages, was therefore obtained. The crack extension/growth developed intensively after the applied stress reached the breakdown pressure. The number of cracks recorded by the AE monitoring system was in good agreement with the amount of deformation (expansion) recorded by the extensometer. The results obtained in this paper provide a better understanding of the hydraulic fracture mechanism which is useful for underground injection projects. © 2014 Springer-Verlag Wien.