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High-trauma fractures in older adults associated with low BMD, osteoporosis
Women who sustained a high-trauma fracture had a 34% greater risk of a subsequent fracture.
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High-trauma nonspine fractures in older women and men are associated with low bone mineral density and an increased risk of a subsequent fracture, according to a new study in the Journal of the American Medical Association.
The findings suggest that older adults who sustain high-trauma nonspine fractures should be evaluated for osteoporosis.
"Women and men with high-trauma fracture should generally be assessed in the same way as those with low-trauma fracture, which usually warrants measurement of BMD (bone mineral density)," the study authors said.
"When decisions are made about osteoporosis treatment for older adults, high-trauma fractures should be considered risk factors for future fractures. Furthermore, since high-trauma fractures are associated with low BMD and predict future fractures, high-trauma fractures should be considered osteoporotic fractures and included as outcomes in clinical trials and observational studies," they said.
Dawn C. Mackey, MSc, of the San Francisco Coordinating Center, San Francisco, and colleagues examined the association between BMD in older adults and risk of high-trauma fracture, and the association between high-trauma fracture and the risk of a subsequent fracture.
The researchers analyzed data from two U.S. studies of adults aged 65 years and older: The Study of Osteoporotic Fractures, which followed 8,022 women for an average of 9.1 years, and the Osteoporotic Fractures in Men Study, which followed 5,995 men for an average of 5.1 years.
Overall, 264 women (3.3%) and 94 men (1.6%) sustained an initial high-trauma fracture, and 3,211 women (40%) and 346 men (5.8%) sustained an initial low-trauma fracture, according to the study.
The researchers found that low BMD was associated with an increased risk of both high- and low-trauma fracture. After adjusting for age, each 1-standard deviation (SD) decrease in total hip BMD was associated with a 45% increased risk of high-trauma fracture in women and a 54% increased risk in men. Similarly, after adjusting for age, a 1-SD decrease in total hip BMD was associated with a 49% greater risk of low-trauma fracture in women and a 69% greater risk in men.
After adjusting for age and total hip BMD, women who sustained a high-trauma fracture had a 34% greater risk of a subsequent fracture compared to women who had not experienced a high-trauma fracture.
Similarly, women who sustained a low-trauma fracture had a 31% greater risk of a subsequent fracture than women who had not experienced a low-trauma fracture.
"In conclusion, BMD was strongly associated with high-trauma nonspine fractures in older women and men, and high-trauma nonspine fractures predicted subsequent fractures to the same extent as low-trauma nonspine fractures in women. Therefore, we concluded that high-trauma nonspine fractures should be considered potential osteoporotic fractures and should receive similar clinical management as low-trauma nonspine fractures," the authors wrote.
For more information:
- Mackey DC, Lui L, Cawthon PM, et al. High-trauma fractures and low bone mineral density in older women and men. JAMA. 2007;298:2381-2388.