Incidence Of Fragility Fractures Research Articles

Association between hypertension and fragility fracture: a longitudinal study

Hypertension is an independent risk factor for osteoporosis and osteoporotic fracture in postmenopausal women. Although hypertension has been suggested to be associated with increased fracture risk, it is not clear whether the association is independent of bone mineral density (BMD). The present study sought to examine the interrelationships between hypertension, BMD, and fracture risk. The study included 1,032 men and 1,701 women aged 50 years and older who were participants in the Dubbo Osteoporosis Epidemiology Study. BMD at the femoral neck and lumbar spine was measured by dual energy X-ray absorptiometry (GE-LUNAR Corp., Madison, WI, USA). The presence of hypertension was ascertained by direct interview and verification through clinical history. The incidence of fragility fractures was ascertained by X-ray report during the follow-up period (1989-2008). The Cox proportional hazards model was used to assess the association between hypertension and fracture risk. Women with hypertension had lower BMD at the femoral neck (0.79 versus 0.82 g/cm(2), P = 0.02) than those without the disease. After adjusting for BMD and covariates, hypertension was an independent risk factor for fragility fracture [hazard ratio (HR), 1.49; 95% CI, 1.13-1.96]. In men, hypertension was associated with higher femoral neck BMD (0.94 versus 0.92 g/cm(2), P = 0.02), but the association between hypertension and fracture risk did not reach statistical significance. Hypertension is associated with increased fracture risk in women, and the association is independent of BMD.

SAT0345 Incidence of subsequent fractures according to site of initial non-vertebral fractures and treatment status: The first 3 years of the optimus initiative

BackgroundAlthough the increase in risk for subsequent fracture following an incident fragility fracture (FF) is well-documented, the impact of the non-vertebral FF site on short-term subsequent fracture risk is less...

SAT0367 Management of fragility fractures: Impact of the optimus initiative on family physicians

BackgroundTo attenuate the osteoporosis (OP) care gap, the OPTIMUS initiative (Osteoporosis and Peripheral fractures: Treatment and Investigation in Multidisciplinary care at the CHUS) was first implemented in the Sherbrooke area...

Progressively increasing fracture risk with advancing age after initial incident fragility fracture: The Tromsø Study

The risk of subsequent fracture is increased after initial fractures; however, proper understanding of its magnitude is lacking. This population-based study examines the subsequent fracture risk in women and men by age and type of initial incident fracture. All incident nonvertebral fractures between 1994 and 2009 were registered in 27,158 participants in the Tromsø Study, Norway. The analysis included 3108 subjects with an initial incident fracture after the age of 49 years. Subsequent fracture (n = 664) risk was expressed as rate ratios (RR) and absolute proportions irrespective of death. The rates of both initial and subsequent fractures increased with age, the latter with the steepest curve. Compared with initial incident fracture rate of 30.8 per 1000 in women and 12.9 per 1000 in men, the overall age-adjusted RR of subsequent fracture was 1.3 (95% CI, 1.2-1.5) in women, and 2.0 (95% CI, 1.6-2.4) in men. Although the RRs decreased with age, the absolute proportions of those with initial fracture who suffered a subsequent fracture increased with age; from 9% to 30% in women and from 10% to 26% in men, between the age groups 50-59 to 80+ years. The type of subsequent fracture varied by age from mostly minor fractures in the youngest to hip or other major fractures in the oldest age groups, irrespective of type and severity of initial fracture. In women and men, 45% and 38% of the subsequent hip or other major fractures, respectively, were preceded by initial minor fractures. The risk of subsequent fracture is high in all age groups. At older age, severe subsequent fracture types follow both clinically severe and minor initial incident fractures. Any fragility fracture in the elderly reflects the need for specific osteoporosis management to reduce further fracture risk.

Former Male Elite Athletes Have Lower Incidence of Fragility Fractures Than Expected

Physical activity during growth is associated with high peak bone mass and may, as a result, prevent osteoporosis later in life. It is therefore possible that athletic activity during youth could lower the risk of fragility fractures in old age. Although this is currently unclear and based on evaluations of surrogate skeletal end point variables in former athletes, we hypothesized that this is not the case. In a retrospective matched controlled cohort study design, we calculated the lifetime incidence of fractures from the results of a mailed questionnaire sent to 709 former male elite athletes with a mean age of 69 yr (range = 50-93 yr) who had given up regular sports activity a mean of 34 yr (range = 1-63 yr) earlier, and to 1368 matched controls. Estimates of time to first fracture were analysed using Poisson regression, and for analyses of covariance, Cox Regression was used. Data are presented as rate ratios (RR) with 95% confidence interval (CI). After retirement from sports, the former athletes had an RR of 0.70 (0.52-0.93) for any fracture, an RR of 0.50 (0.27-0.89) for any fragility fracture, and an RR of 0.29 (0.09-0.74) for distal radius fractures. When adjusting for occupation, smoking, alcohol, disease, and medication the hazard ratio (HR) of any fracture after an active career was 0.73 (95% CI = 0.54-0.99) and the hazard ratio of any fragility fracture after age 50 yr was 0.63 (95% CI = 0.35-1.16). In men, elite sports during adolescence are associated with a lower fracture risk after career end. The former athletes were overall healthier, which may have influenced the results.

Low BMD is an independent predictor of fracture and early menopause of mortality in post-menopausal women – A 34-year prospective study

ObjectiveIdentify risk factors for fragility fractures and mortality in women aged 48. Study designProspective population-based observational study on 390 white north European women aged 48 at study start. At study start, we measured bone mineral density (BMD) by single-photon absorptiometry (SPA) in the distal forearm, anthropometry by standard equipment and registered menopausal status, health and lifestyle factors. Menopause before age 47 was defined as early menopause. Incident fragility fractures and mortality were recorded until the women reached age 82. Potential risk factors for fragility fracture and mortality were evaluated with Cox's proportional hazard regression analysis. Data are presented as risk ratios (RR) with 95% confidence intervals in brackets. Main outcome measuresIncidence of fragility fractures and mortality. ResultsIn the univariate analysis, low BMD and early menopause predicted fractures. In the multivariate analysis, only BMD remained as an independent risk factor with a RR of 1.36 (1.15, 1.62) per standard deviation (SD) decrease in baseline BMD. In the univariate analysis, early menopause and smoking predicted mortality, and remained as independent risk factors in the multivariate analysis with RR 1.62 (1.09, 2.39) for early menopause and 2.16 (1.53, 3,06) for smoking. ConclusionsLow BMD at age 48 is an independent predictor for fragility fractures. The predictive ability of early menopause is at least partially attributed to other associated risk factors. Early menopause and smoking were found in this study to be independent predictors for mortality.

Bisphosphonate Drug Holiday: Choosing Appropriate Candidates

Osteoporosis related fractures contribute to morbidity and mortality in U.S. patients, placing a heavy financial burden on society. Randomized clinical trials involving over 30,000 subjects have established bisphosphonates' efficacy in reducing the incidence of fragility fractures. However, as bisphosphonates are retained for years in the skeleton, reports of adverse events from prolonged use are surfacing in the literature, namely, esophageal cancer, atrial fibrillation, osteonecrosis of the jaw, and atypical fracture development. The concept of a drug holiday has been proposed to potentially reduce incidence of these adverse events. This review will highlight the benefits and risks of bisphosphonate therapy and discuss the extension data available from the bisphosphonate trials. As randomized clinical trial evidence is not yet available on who may qualify for drug holiday, this review will provide suggestions for clinicians on identification of possible candidates and monitoring during a bisphosphonate drug holiday.

Oral bisphosphonate use in the elderly is not associated with acute kidney injury

Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR <60 ml/min per 1.73 m(2)). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.

Five-year follow-up study of a kidney-tonifying herbal Fufang for prevention of postmenopausal osteoporosis and fragility fractures

To observe the kidney-tonifying herbal Fufangs with phytoestrogenic epimedium for prevention of postmenopausal osteoporosis with both bone mineral density (BMD) and fracture as study endpoints, a 5-year multicenter follow-up study in 194 postmenopausal women (47-70years old) was conducted in which the subjects were given oral administration of herbal Fufang (10g/day, twice per day, n=101) or placebo (n=93). Both groups were supplemented daily with calcium (600mg) and vitamin D (400IU). BMD at distal radius, potential adverse events, and fracture incidence were evaluated at baseline and at 6, 12, 24, 36, 48, and 60months. At the end of 5 years, 155 subjects had completed the study, with better adherence in the treatment group (13% dropouts, n=88 at year5) as compared with the control group (28% dropouts, n=67 at year5) (P<0.05). No notable adverse events were observed in either group. In the treatment group BMD increased significantly from baseline (0.211±0.022g/cm(2)) to the end of the study (0.284±0.015g/cm(2)), whereas the control group decreased significantly from baseline (0.212±0.023g/cm(2)) to 5years later (0.187±0.022g/cm(2)) (P<0.05). The fracture incidence was 2.4 fold lower in the treatment group than in the control group, with a relative risk of 0.57 for the treatment group (95% CI, 0.43-0.70, P<0.05). In conclusion, in addition to the beneficial effects of oral herbal Fufang on prevention of postmenopausal bone loss, this 5-year multi-center clinical study demonstrated for the first time its potential for reduction in fragility fracture incidence.

Former male elite athletes have a lower incidence of fragility fractures than expected

Former male elite athletes have a lower incidence of fragility fractures than expected

Early menopause and risk of osteoporosis, fracture and mortality: a 34‐year prospective observational study in 390 women

A prospective evaluation of the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis. Prospective population-based observational study. Malmö, Sweden. A total of 390 white north European women aged 48 years at the start of the study. At baseline, bone mineral density (BMD) was measured by single-photon absorptiometry (SPA) in the distal forearm and menopausal status was noted. Menopause was determined according to the World Health Organization criterion of a minimum of 12 months of continuous amenorrhoea. Women were divided into early menopause (occurring before age 47 years) and late menopause (occurring at age 47 years or later). At age 77, forearm BMD was re-measured by SPA and proximal femur and lumbar spine BMD were measured by dual-energy X-ray absorptiometry (DXA). The prevalence of osteoporosis was determined using the DXA data. Mortality rate and the incidence of fractures were registered up until age 82. Data are presented as means with 95% confidence intervals (95% CI). Incidence of fragility fractures, mortality, prevalence of osteoporosis at age 77. Women with early menopause had a risk ratio of 1.83 (95% CI 1.22-2.74) for osteoporosis at age 77, a risk ratio of 1.68 (95% CI 1.05-2.57) for fragility fracture and a mortality risk of 1.59 (95% CI 1.04-2.36). Menopause before age 47 is associated with increased mortality risk and increased risk of sustaining fragility fractures and of osteoporosis at age 77.

Incidence of fractures of the femur, including subtrochanteric, up to 8 years since initiation of oral bisphosphonate therapy: a register-based cohort study using the US MarketScan claims databases

In a cohort study of users of bisphosphonates, we evaluated the incidence of fragility fractures at all sites on the femur following for up to 8 years of therapy with alendronate or risedronate. We did not find evidence for a reversal of fracture protection with long-term use of bisphosphonates. Few studies have acquired adequate data with prolonged follow-up on bisphosphonate users in the general population to evaluate their long-term effects on the risk of hip fractures including those in the subtrochanteric region. This cohort study utilizes a large USA database (January 1, 2000 to June 30, 2009). We compared patients with higher versus lower degrees of compliance [medication possession ratio, MPR <1/3 (the reference), 1/3-<2/3, or ≥ 2/3]. Radiographic adjudication of fracture site and features were not performed. Hazard ratios (HR) for fracture were estimated using time-dependent Cox models. Restricted cubic splines (RCS) were used to plot HRs for fracture against duration of therapy. There were 3,655 incident cases of femoral fracture (764 subtrochanteric/shaft, 2,769 hip) identified during 917,741 person-years of follow-up (median = 3 years) on 287,099 patients (267,374 were women) from the date when they initiated oral bisphosphonate therapy. The corresponding HRs (95% confidence interval, CI) for overall femoral fractures associated with each additional year of therapy were 0.93 (0.86-1.01) within 5 years, and 0.89 (0.77-1.03) beyond 5 years for risedronate and 0.86 (0.81-0.91) and 0.95 (0.84-1.07) for alendronate, respectively. The corresponding estimates for subtrochanteric/shaft fractures were 1.05 (0.87-1.26) and 0.89 (0.60-1.33) for risedronate and 0.99 (0.92-1.05) and 1.05 (0.92-1.20) for alendronate, respectively. The HRs (95% CI) for overall femoral fractures associated with each additional year of alendronate or risedronate therapy within 5 and beyond 5 years were not significantly different. Our study showed persistence of overall hip fracture protection with long-term use of alendronate or risedronate.

Osteoporosis, osteopenia and fracture risk: Widening the therapeutic horizons

The majority of women with fragility fractures have osteopenia rather than osteoporosis. In post hoc analyses of trials of alendronate and strontium ranelate, women with osteopenia had significant reductions in the incidence of fragility fractures and specific therapies may be mandated in women with osteopenia, as well as those with osteoporosis. Increasing numbers of fractures of the spine and hip occur in very elderly women and men over the age of 80, but in this age group it is often considered too late in life to start long-term specific therapies. In clinical trials of very elderly women, risendronate significantly reduced vertebral fractures and strontium ranelate significantly reduced vertebral, non-vertebral and symptomatic clinical fractures within 1 year of starting treatment. The indications for specific therapies for osteopenia and osteoporosis, as well as other measures for the prevention and treatment of fragility fractures, urgently need to be increased and widened.

Effects of Raloxifene on Bone Metabolism in Hemodialysis Patients

Effects of Raloxifene on Bone Metabolism in Hemodialysis Patients

Physical activity as a strategy to reduce the risk of osteoporosis and fragility fractures.

Childhood and adolescence are critical periods for the skeleton. Mechanical load has then been shown to be one of the best stimuli to enhance not only bone mass, but also structural skeletal adaptations, as both contributing to bone strength. Exercise prescription also includes a window of opportunity to improve bone strength in the late pre- and early peri-pubertal period. There is some evidence supporting the notion that skeletal gains obtained by mechanical load during growth are maintained at advanced age despite a reduction of physical activity in adulthood. The fact that former male athletes have a lower fracture risk than expected in their later years does not oppose the view that physical activity during growth and adolescence is important and it should be supported as one feasible strategy to reduce the future incidence of fragility fractures.

Therapeutische und prophylaktische Effekte von Sport und Training bei Osteoporose und Fraktur Risiko

Osteoporosis and low bone strength in older people may be due to low bone mass accrual or elevated age-related loss of bone mass. The mechanisms underlying loss of bone mass have long been subjected to research. However, research has only started in the last decade to focus on strategies to increase bone mass:the current opinion is that childhood and adolescence are critical periods for building up bone mineral density. It is also known that life style factors, such as physical activity may influence the accrual of bone mineral density Mechanical loading has been shown to be one of the best stimuli to enhance not only bone mass but also structural skeletal adaptations. both independently contributing to bone strength. Exercise prescription also includes a window of opportunity to improve bone strength in the late pre- and early pen-pubertal period. There is some evidence supporting the notion that gains inbone mass obtained by mechanical loading during growth are maintained at older age despite reduction of physical activity in adulthood. The notion that former male athletes have a lower fracture risk compared to non-athlets of the same age suggests that physical activity during growth and adolescence should be recommended as a feasible strategy to reduce the future incidence of fragility fractures. (Less)

Predicting fracture using 2D finite element modelling

A decrease in bone density at the hip or spine has been shown to increase the risk of fracture. A limitation of the bone mineral density (BMD) measurement is that it provides only a measure of a bone sample's average density when projected onto a 2D surface. Effectively, what determines bone fracture is whether an applied load exceeds ultimate strength, with both bone tissue material properties (can be approximated through bone density), and geometry playing a role. The goal of this project was to use bone geometry and BMD obtained from radiographs and DXA measurements respectively to estimate fracture risk, using a two-dimensional finite element model (FEM) of the sagittal plane of lumbar vertebrae. The Canadian Multicentre Osteoporosis Study (CaMos) data was used for this study. There were 4194 men and women over the age of 50 years, with 786 having fractures. Each subject had BMD testing and radiographs of their lumbar vertebrae. A single two dimensional FEM of the first to fourth lumbar vertebra was automatically generated for each subject. Bone tissue stiffness was assigned based on the BMD of the individual vertebrae, and adjusted for patient age. Axial compression boundary conditions were applied with a force proportional to body mass. The resulting overall strain from the applied force was found. Men and women were analyzed separately. At baseline, the sensitivity of BMD to predict fragility fractures in women and men was 3.77% and 0.86%, while the sensitivity of FEM to predict fragility fractures for women and men was 10.8% and 11.3%. The FEM ROC curve demonstrated better performance compared to BMD. The relative risk of being considered at high fracture risk using FEM at baseline, was a better predictor of 5 year incident fragility fracture risk compared to BMD.

Fragility fractures in the elderly: Evolving approaches in the NHS

Fragility fractures account for a significant proportion of trauma admissions and clinic attendances in the UK. Hip fractures constitute a major part of these fractures followed by wrist, spine and humerus. With the increasing elderly population and increasing life expectancy, incidences of these fractures have increased proportionately. Hip fractures cause significant morbidity and mortality because of existing medical co-morbidities or perioperative complications. In order to decrease the overall incidence of osteoporotic fractures and improve outcome of surgical treatment, different approaches to prevention and treatment are currently evolving throughout the NHS. These include primary prevention through management of osteoporosis and secondary prevention aimed at treating osteoporosis and reducing further fractures. In this article, we highlight the different care pathways that could effectively decrease the incidence of fragility fractures as well as the morbidity and mortality in these patients.

What Is the Role of the Orthopaedic Surgeon in Management of Fragility Fractures?

Fragility fractures are the most prevalent trauma condition that orthopaedic surgeons face today. Osteoporosis and susceptibility to falls are the key predisposing factors. Despite evidence supporting the impact of treating osteoporosis on reducing the incidence of fragility fractures, it is often left untreated. Orthopaedic surgeons are often the first physicians to assess and treat the patient after a fragility fracture. Their role therefore does not end in the skillful fixation of the fractures, but they have a unique opportunity to ensure that preventive measures are implemented. This includes falls prevention, investigation of possible causes underlying osteoporosis, attention to diet, exercise, calcium, and vitamin D supplementation as well as prescription of anti-resorptive and anabolic medication. The need for a dedicated multidisciplinary team needs to be emphasized and therefore effective communication between the different parties is of paramount importance.

The incidence of fragility fractures in Italy

The incidence of fragility fractures in Italy