Article

High-trauma fractures and low bone mineral density in older women and men. JAMA

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 12/2007; 298(20):2381-8. DOI: 10.1001/jama.298.20.2381
Source: PubMed

ABSTRACT It is widely believed that fractures resulting from high trauma are not osteoporotic; however, this assumption has not been studied prospectively.
To examine the association between bone mineral density (BMD) and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men.
Two prospective US cohort studies in community-dwelling adults 65 years or older from geographically diverse sites. The Study of Osteoporotic Fractures followed up 8022 women for 9.1 years (1988-2006). The Osteoporotic Fractures in Men Study followed up 5995 men for 5.1 years (2000-2007).
Hip and spine BMD were assessed by dual-energy x-ray absorptiometry. Incident nonspine fractures were confirmed by radiographic report. Fractures were classified, without knowledge of BMD, as high trauma (due to motor vehicle crashes and falls from greater than standing height) or as low trauma (due to falls from standing height and less severe trauma).
Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3211 women and 346 men sustained an initial low-trauma fracture. For women, each 1-SD reduction in total hip BMD was similarly associated with an increased risk of high-trauma fracture (multivariate relative hazard [RH], 1.45; 95% confidence interval [CI], 1.23-1.72) and low-trauma fracture (RH, 1.49; 95% CI, 1.42-1.57). Results were consistent in men (high-trauma fracture RH, 1.54; 95% CI, 1.20-1.96; low-trauma fracture RH, 1.69; 95% CI, 1.49-1.91). Risk of subsequent fracture was 34% (95% CI, 7%-67%) greater among women with an initial high-trauma fracture and 31% (95% CI, 20%-43%) greater among women with an initial low-trauma fracture, compared with women having no high- or low-trauma fracture, respectively. Risk of subsequent fracture was not modeled for men.
Similar to low-trauma nonspine fractures, high-trauma nonspine fractures are associated with low BMD and increased risk of subsequent fracture in older adults. High-trauma nonspine fractures should be included as outcomes in osteoporosis trials and observational studies.

0 Followers
 · 
151 Views
 · 
0 Downloads
  • Source
    • "The relationship between osteoporosis and fracture risk is well-established (Mackey et al. 2007; Marshall et al. 1996); osteoporosis at a skeletal site is highly predictive of a fracture in the same area. The Cd-associated increased risk of osteoporosis observed in some studies is thus of concern (Alfvén et al. 2000; Engström et al. 2011, 2012; Gallagher et al. 2008; Nawrot et al. 2010; Staessen et al. 1999; Wang et al. 2003; Wu et al. 2010) (Table 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Exposure to cadmium (Cd) has long been recognized as a health hazard, both in industry and in general populations with high exposure. Under the currently prevailing health risk assessment, the relationship between urinary Cd concentrations (U-Cd) and tubular proteinuria is used. However, doubts have recently been raised regarding the justification of basing the risk assessment on this relationship at very low exposure. The objective of this paper is to review available information on health effects of Cd exposure with respect to human health risk assessment. The associations between U-Cd and U-proteins at very low exposure may not be due to Cd toxicity and the clinical significance of slight proteinuria may also be limited. More importantly, other effects have been reported at very low Cd exposure. There is reason to challenge the basis of the existing health risk assessment for Cd. Our review of the literature found that exposure to low concentrations of Cd is associated with effects on bone including increased risk of osteoporosis and fractures, and that this observation has implications for the health risk assessment of Cd. Other effects associated with Cd should also be considered, in particular cancer, though the information is still too limited for appropriate use in quantitative risk assessment. Non-renal effects should be considered critical effects in the health risk assessment of Cd.
    Environmental Health Perspectives 02/2014; 122(5). DOI:10.1289/ehp.1307110 · 7.98 Impact Factor
  • Source
    • "Thus, algorithms for fractures may capture traumatic fractures and fractures related to malignancy as well. On the other hand, studies have shown that even highetrauma nonspine fractures are associated with low bone mineral density [28] and increased risk of subsequent fractures and that there was no evidence of cancer in 75% of patients with vertebral fractures coded as pathologic [29]. Thus, excluding traumatic and pathologic fractures may in fact underestimate the prevalence of osteoporosis in administrative data sets. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the validity of the diagnostic algorithms for osteoporosis and fractures in administrative data. A systematic search was conducted to identify studies that reported the validity of a diagnostic algorithm for osteoporosis and/or fractures using administrative data. Twelve studies were reviewed. The validity of the diagnosis of osteoporosis in administrative data was fair when at least 3 years of data from hospital and physician visit claims were used (area under the receiver operating characteristic [ROC] curve [AUC]=0.70) or when pharmacy data were used (with or without the use of hospital and physician visit claims data, AUC>0.70). Nonetheless, the positive predictive values (PPVs) were low (<0.60). There was good evidence to support the use of hospital data to identify hip fractures (sensitivity: 69-97%; PPV: 63-96%) and the addition of physician claims diagnostic and procedural codes to hospitalization diagnostic codes improved these characteristics (sensitivity: 83-97%; PPV: 86-98%). Vertebral fractures were difficult to identify using administrative data. There was some evidence to support the use of administrative data to define other fractures that do not require hospitalization. Administrative data can be used to identify hip fractures. Existing diagnostic algorithms to identify osteoporosis and vertebral fractures in administrative data are suboptimal.
    Journal of clinical epidemiology 03/2013; 66(3):278-85. DOI:10.1016/j.jclinepi.2012.10.004 · 5.48 Impact Factor
  • Source
    • "A more novel result is our finding that FRAX predicted fractures at other skeletal sites about as well as it did major osteoporotic fractures. This might be expected from the fact that bone density predicts fracture risk generally in older individuals [6] and, indeed, predicts fractures attributed to high-energy traumatic events as well as it does those resulting from falls [21, 22]. This is clinically relevant since the overall societal burden of fractures is not limited to the traditional osteoporotic fractures. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine if the revised US FRAX can identify those at high risk for fractures at any skeletal site, we studied 250 women and 249 men ≥40 years old from an age-stratified random sample of Rochester, MN residents. At baseline, femoral neck (FN) bone density was assessed, as were the clinical risk factors included in FRAX, along with additional fracture risk factors such as bone turnover markers and fall history. Fracture ascertainment through periodic interviews and comprehensive medical record review was performed over 10 years of followup. In both women and men, a higher FRAX probability at baseline was associated with greater subsequent likelihood of a major osteoporotic fracture. However, a relative 10% increase in the FRAX 10-year fracture probability was also associated with a 1.4-fold increase (95% confidence interval (CI) 1.1-1.7) in other fractures in women and a 1.7-fold increase (95% CI 0.8-3.1) in men. Furthermore, FRAX predicted asymptomatic vertebral fractures and fractures generally in both sexes. The addition of risk factors not currently included in FRAX did not appear to improve the accuracy of fracture risk prediction. FRAX may provide a conservative estimate of risk for major osteoporotic fractures, but it also predicts fractures generally.
    Journal of Osteoporosis 08/2012; 2012:528790. DOI:10.1155/2012/528790
Show more