Abstract
Background: Osteoporotic fractures are defined as low-impact fractures resulting from low-level trauma. However, the exclusion of high-level trauma fractures may result in underestimation of the contribution of osteoporosis to fractures. In this study, we aimed to investigate the fracture patterns of female trauma patients with various risks of osteoporosis based on the Osteoporosis Self-Assessment Tool for Asians (OSTA) score. Methods: According to the data retrieved from the Trauma Registry System of a Level I trauma center between 1 January 2009 and 31 December 2015, a total of 6707 patients aged ≥40 years and hospitalized for the treatment of traumatic bone fracture were categorized as high-risk (OSTA < −4, n = 1585), medium-risk (−1 ≥ OSTA ≥ −4, n = 1985), and low-risk (OSTA > −1, n = 3137) patients. Two-sided Pearson’s, chi-squared, or Fisher’s exact tests were used to compare categorical data. Unpaired Student’s t-test and Mann–Whitney U-test were used to analyze normally and non-normally distributed continuous data, respectively. Propensity-score matching in a 1:1 ratio was performed with injury mechanisms as adjusted variables to evaluate the effects of OSTA-related grouping on the fracture patterns. Results: High- and medium-risk patients were significantly older, had higher incidences of comorbidity, and were more frequently injured from a fall and bicycle accident than low-risk patients did. Compared to low-risk patients, high- and medium-risk patients had a higher injury severity and mortality. In the propensity-score matched population, the incidence of fractures was only different in the extremity regions between high- and low-risk patients as well as between medium- and low-risk patients. The incidences of femoral fractures were significantly higher in high-risk (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.73–4.24; p < 0.001) and medium-risk patients (OR, 1.4; 95% CI, 1.24–1.54; p < 0.001) than in low-risk patients. In addition, high-risk patients had significantly lower odds of humeral, radial, patellar, and tibial fractures; however, such lower odds were not found in medium- risk than low-risk patients. Conclusions: The fracture patterns of female trauma patients with high- and medium-risk osteoporosis were different from that of low-risk patients exclusively in the extremity region.
Highlights
Osteoporotic fractures are defined as low-impact fractures resulting from low-level trauma, such as a fall from a standing height or less that would not ordinarily result in fracture [2,3]
In a study that compared the bone mineral density (BMD) of a random sample of women who sustained fractures in either low- or high-level trauma events, the results revealed that, in a high-energy trauma, patients with osteoporosis are more prone to fracture than those without osteoporosis [7]
The main question is, in the event of trauma, is the location of fractures in patients at high- or medium risk for osteoporosis tend to be different from those at low-risk for osteoporosis? this study aimed to investigate the fracture patterns of patients with different risks of osteoporosis based on the Osteoporosis Self-Assessment Tool for Asians (OSTA) score of female trauma patients in a Level I
Summary
Osteoporotic fractures are defined as low-impact fractures resulting from low-level trauma. In the propensity-score matched population, the incidence of fractures was only different in the extremity regions between high- and low-risk patients as well as between medium- and low-risk patients. Conclusions: The fracture patterns of female trauma patients with high- and medium-risk osteoporosis were different from that of low-risk patients exclusively in the extremity region. Fractures are not always associated with low BMD [6] Under such definition, bone fragility does not presumably contribute to fractures associated with a high-level trauma. In a study that compared the BMD of a random sample of women who sustained fractures in either low- or high-level trauma events, the results revealed that, in a high-energy trauma, patients with osteoporosis are more prone to fracture than those without osteoporosis [7]. The exclusion of high-level trauma fractures may result in the underestimation of the contribution of osteoporosis to fractures [7]
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