SAN FRANCISCO, California—Older adults who suffer high-trauma nonspine fractures (including those from car crashes or falls from greater than standing height) should be evaluated for osteoporosis, finds a new study in the November 28 issue of the Journal of the American Medical Association.¹

"High trauma nonspine fractures should be considered potential osteoporotic fractures and should receive similar clinical management as low-trauma nonspine fractures," conclude the researchers led by Dawn C. Mackey, MSc, of the San Francisco Coordinating Center, California Pacific Medical Center Research Institute.

1 SD drop in hip BMD = 45% increase in high-trauma fracture risk

The researchers analyzed data from two US studies of adults aged >e;65 years including the Study of Osteoporotic Fractures, which followed-up 8022 women for 9.1 years (1988-2006), and the Osteoporotic Fractures in Men Study, which followed-up 5995 men for 5.1 years (2000-2007). They examined the association between bone mineral density (BMD) and risk of high-trauma fracture and the association between this type of fracture and risk of a subsequent fracture. Researchers measured hip and spine BMD with dual-energy X-ray absorptiometry and confirmed new nonspine fractures by radiograph. Fractures were classified as high trauma or low 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 during the study period. Low BMD was associated with an increased risk of high- and low-trauma fracture, the study showed.

In women, each 1-SD (standard deviation) decrease in total hip BMD was associated with a 45% increased risk of high-trauma fracture after adjusting for age. In men, each 1-SD decrease in total hip BMD was associated with a 54% increased risk after adjusting for age. Additionally, 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.

Women who sustained a high-trauma fracture had a 34% increased risk of sustaining a subsequent fracture compared with women who had not experienced a high-trauma fracture after the researchers adjusted for age and total hip BMD. 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.

"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," the authors write.

Doctors need to measure BMD in high-trauma fracture patients

In an accompanying editorial, Sundeep Khosla, MD, of Mayo Clinic in Rochester, Minnesota, writes that the new study "has potential clinical importance."²

Dr. Khosla told MSKReport.com that in the past high-trauma fractures were more or less considered nonosteoporotic fractures.

"But," he explains, "we can't ignore these fractures especially in older patients who fall off a chair and break their wrist or get a rib fracture in car accident. The physician should pause and think ‘does this person have osteoporosis' and evaluate them for that rather then saying ‘don't worry about it because the fracture occurred in significant or high trauma.'"

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