Study identifies fractures most and least likely to be caused by osteoporosis
Fractures of the femoral neck, fractures of the vertebrae not due to trauma, and fractures of the lumbar and thoracic vertebrae are the skeletal fractures most likely to be due to osteoporosis in older patients, according to a new study. Fractures least likely to be associated with osteoporosis are open (wound-related) fractures of the proximal humerus (the end of the bone near the body), skull fractures, and fractures of the facial bones. Without consistent definitions for "fragility fracture" or "osteoporotic fracture," meaningful comparisons of efficacy cannot be done between clinical trials of different therapies. In addition to setting a consensus on definitions and identifying general osteoporosis-related (or -unrelated) fractures, the study's expert panel report some age- and race-associated differences. For example, open fractures of the arm (other than the proximal humerus) and fractures of the tibia or fibula, patella, ribs, and sacrum are likely to be associated with osteoporosis in white women over 80 years old, but the connection is less likely in younger black men (ages 65-80 years).
The researchers conducted a systematic review of research on fractures and osteoporosis in the elderly from January 1999 through December 2008. From 4,016 articles initially identified, abstract review left 168 potentially relevant articles. Of these, 68 were suitable for detailed review and abstraction of data elements. The resulting evidence report summarized the published estimates of fracture risk associated with osteoporosis for each anatomic site, as well as the possible association of fractures with other clinical risk factors (age, sex, trauma, glucocorticoid use, and chronic kidney disease).
The report was used by the expert panel in a several stage process to score the likelihood of fractures happening due to osteoporosis in patients at least 65 years old and those older than 80 years. Because little data existed on members of other races and ethnic groups, racial comparison was limited to blacks and whites. The study was funded in part by the Agency for Healthcare Research and Quality (HS16956).
More details are in "Which fractures are most attributable to osteoporosis?" by Amy H. Warriner, M.D., Nivedita M. Patkar, M.D., M.S.P.H., Jeffrey R. Curtis, M.D., M.S., M.P.H., and others, in the Journal of Clinical Epidemiology 64(1), pp. 46-53, 2011.
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