Osteoporosis and fall risk in patients with fragility fractures

Abstract

Low BMD and fall risk are well-documented risk factors for fractures. The prevalence of both risk factors has only scarcely been reported in the same population of patients with recent clinical fractures. Methods : 261 consecutive patients (women and men of 50 years and older) admitted to the hospital with a recent clinical fracture were included and had extensive evaluation of bone mineral density (BMD) and fall risk (135 patients with fracture of the upper limb, 94 of the lower limb, 12 of the spine, 10 other and 10 multiple simultaneous fractures). Fractures after a car accident were excluded. BMD was measured in the spine and hip using DXA and expressed in gender-specific T-scores. Other evaluated risk factors included an ADL-score (the Groningen Activity Restriction Scale (GARS)), the Timed Get up and Go test (TGUGT), chair stand test, the four test balance scale and classic risk factors for fractures. Results: Osteoporosis in the spine or hip was present in 41% of the patients and osteopenia in 41%. The prevalence of other risk factors for fractures ranged from 2% (use of glucocorticoids) to 34% (osteoarthritis). Patients with classic osteoporotic fractures (clinical spine, humerus, forearm, femur or multiple fractures) (n=158) were older (70 vs. 64 years; p <0.001), had lower Z-score in the hip (-0.4 vs. +0.2; p <0.001), higher GARS (14.7 vs. 12.5, p <0.01), lower body weight (68 kg vs. 74 kg; p <0.01), more disturbed balance (standing on one leg timed: 13 sec vs. 20 sec; p <0.001) and lower hand grip strength (52 kg vs. 63 kg, p <0.05) than patients with other fractures. Conclusions: Patients with clinical fractures had a wide spectrum of risks for fractures in terms of BMD and non-BMD related risks, including fall risk. Patients with classic osteoporotic fractures had lower BMD in the hip and more other risk factors fro fractures and falls than patients with other fractures, including lower muscle strength. These results indicate that patients with clinical fractures should have attention for both osteoporosis and fall risk in order to target the right population with the right treatment