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Study: 2/3rd of All Fractures Are Not Attributable to Osteoporosis
Wanted to share this interesting 2019 article from The Journal of Clinical Endocrinology & Metabolism titled: Two-Thirds of All Fractures Are Not Attributable to Osteoporosis and Advancing Age: Implications for Fracture Prevention.
https://academic.oup.com/jcem/article/104/8/3514/5427152
From the article:
Although bone mineral density (BMD) is strongly associated with fracture and post-fracture mortality, the burden of fractures attributable to low BMD has not been investigated.
In this long-term study, we demonstrated that only 16% of total fractures in women and 15% of total fractures in men were attributable to low BMD (defined as BMD T-score ≤−2.5). When low BMD was combined with advancing age, the two factors accounted for approximately one-third of all fractures. In other words, advancing age and osteoporosis did not capture 65% of all fracture cases.
Moreover, almost 53% of women and 90% of men who sustained a fracture had BMD T-scores >−2.0. These observations underline the fact that the relationship between BMD and fracture risk is continuous and that there is not really a clear cutoff value that defines high risk vs low risk. This finding also underscores the idea that fracture risk assessment for a patient should consider BMD as a continuous variable rather than being based on arbitrary classification.
Conclusions
A substantial health care burden of fracture is on people aged <70 years or non-osteoporosis, suggesting that treatment of people with osteoporosis is unlikely to reduce a large number of fractures in the general population.
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Thank you. Interesting information
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3 ReactionsDo these fractures include “traumatic fractures “ such as car accidents and cancer etc?
"almost 53% of women and 90% of men who sustained a fracture had BMD T-scores >−2.0."
In other words, nearly half the women had osteopenia or worse.
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1 Reaction@leslie2121 No, those were excluded. From the report: "Fractures were included only if the report of fracture was definite and it was confirmed on interview that it had occurred with low trauma. We excluded fractures from analysis if they resulted from major trauma (e.g., motor vehicle accident) or were related to disease such as cancer or bone-related diseases, or those of the digit, skull, or cervical spine. In this study, we focused primarily on hip fracture, vertebral fracture, and wrist fracture because of their common frequency to ensure adequate statistical power for analysis of association."
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2 Reactions@njx58 Some of the analysis in the report are a bit confusing and make me want to do more research into the study and the results.
However, in the discussion it summarizes: "In this long-term study, we demonstrated that only 16% of total fractures in women and 15% of total fractures in men were attributable to low BMD (defined as BMD T-score ≤−2.5). When low BMD was combined with advancing age, the two factors accounted for approximately one-third of all fractures. In other words, advancing age and osteoporosis did not capture 65% of all fracture cases."
it has recently been shown that a majority of fractures actually occur in those without osteoporotic BMD. In this study we confirmed that observation. Indeed, almost 73% of women and 94% of men who had sustained a fracture did not have osteoporotic BMD at baseline."
@daisy17 wow!!
If the conclusion is "don't bother worrying about bone density", there is no doctor in the world who would say that, so I'm not sure what the takeaway is. Also, if a third of fractures are because of OP, that's still a whole lot of people.
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