Study: 2/3rd of All Fractures Are Not Attributable to Osteoporosis

Thank you. Interesting information

Do 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.

@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."

@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.

@njx58 I thought the study's message was that "low BMD has been recognized as the most robust risk factor for fragility fracture." But if the majority of fractures actually occur in those without osteoporotic BMD, then doctors should put greater focus on risk factors other than BMD.

One of the most significant factors that contribute to fractures in the elderly is a fall. The report says "A history of fall was associated with a fourfold increase in fracture risk. Thus, it can be estimated that ≤47% of hip fractures are attributable to fall. "

BMD is important, of course, but also important in fracture prevention is physical strength, balance, proper nutrition and protein levels etc. So, doctors should also encourage patients to keep physically active, do exercises that maintain or improve leg strength and balance.

This article seems to correlate with this subject, "The Real Risk Behind Fractures: Why Fall Prevention Matters More Than You Think" by Dr. Susan E. Brown, PhD

In one study, "veterans who started medications to lower blood pressure saw a doubling in hip fracture risk within just 30 days. Why? Because one common side effect of these medications is dizziness or lightheadedness when standing—a recipe for falls. Even more eye-opening: within those first 30 days, there was a 50% increase in fracture rates."

She points out that "Fall Prevention Is Fracture Prevention" and we need to look carefully at medications, and also focus on helping older people maintain their balance, strength, and coordination.
https://betterbones.com/fractures-and-healing/the-real-risk-behind-fractures-why-fall-prevention-matters-more-than-you-think/

@daisy17 I read this a bunch of times also. I think they are saying a lot of fractures were osteopenia but between -2.0 and -2.5. They mentioned the risk is more continuous and not just if you are -1.9 that is way better than -2.5. And people under -2.5 are not being treated. But the broader issue I think you or someone mentioned is the treatment of this group could or should be focused on balance, strength, nutrition, etc. They didn't mention all that as it was not the purpose of the analysis. Only if we don't look at this group we will not see a large decrease in fractures.