High-Trauma Fractures In Older Men, Women Linked To Osteoporosis

Armen Hareyan's picture


Researchersat the California Pacific Medical Center (CPMC) Research Institute arechallenging a widely held belief that fractures resulting from major trauma,such as automobile accidents, are not related to osteoporosis, the commondisease that makes bones weak and prone to fracture. Their study, published inthe November 28 issue of the Journal of the American Medical Association, wassupported by the National Institute of Arthritis and Musculoskeletal and SkinDiseases (NIAMS), and the National Institute on Aging (NIA). NIAMS and NIA arecomponents of the National Institutes of Health.

People withosteoporosis, a condition of low bone mineral density, experience fracturesfrom a level of force that would not break a healthy bone. Although cliniciansoften recognize fractures resulting from minimal trauma as osteoporotic, thoserelated to more substantial injury are rarely given the same consideration. "Weknow that too many clinicians pass on any follow-up of many fracture patientsbecause, in their minds, the patient 'earned' their fracture," says JoanA. McGowan, Ph.D., director of the Division of Musculoskeletal Diseases atNIAMS. "These missed opportunities can have a devastating impact on thesemen and women, who, without proper management, are at increased risk forsubsequent fracture."

CPMC'sSteven R. Cummings, M.D., and his colleagues analyzed data from two largeprospective cohort studies: the Study of Osteoporotic Fractures (SOF) in womenand the Osteoporotic Fractures in Men Study (Mr. OS). The SOF followed 8,022women for nine years and Mr. OS tracked 5,995 men for five years. Bone mineraldensity (BMD) was assessed by dual-energy X-ray absorptiometry (DXA). Studyparticipants were contacted every four months to determine whether theyexperienced a fracture in the previous four-month period.


When afracture was reported, clinical staff interviewed the participant to learn howit occurred. Without knowledge of the participant's BMD, staff classified eachfracture as high-trauma or low-trauma. High-trauma fractures were defined asthose caused by motor vehicle crashes and falls from greater than standingheight, and low-trauma fractures were defined as those resulting from fallsfrom standing height and less severe trauma.

Cummingsand his team discovered that the relationship between BMD and fracture risk wassimilar for high-trauma and low-trauma fractures. They also found that womenwho experienced a high-trauma fracture were at increased risk for futurefractures. (A similar analysis was not conducted in men because of the shorterfollow-up time.) "It is becoming increasingly clear that any fractureexperienced by an older individual is worthy of an osteoporosisevaluation," says Sheryl S. Sherman, Ph.D., Geriatrics and ClinicalGerontology Branch, NIA.

"Webelieve that this study changes the definition of osteoporotic fracture and expands the number of fractures thatshould be considered as such," Cummings says. "Moreover, it iscritical that fractures that occur as a result of high trauma be included asoutcomes in future studies, so that we may fully understand the impact of thesefractures and develop strategies to prevent them."