An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. Incidence and economic burden of osteoporosis-related fractures in the United States, J Bone Miner Res.
World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Predictors of non-spine fracture in elderly men: the MrOS study.
Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol. Which fractures are associated with low appendicular bone mass in elderly women?
Ann Intern Med. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures.
Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study. Cross-sectional versus longitudinal evaluation of bone loss in men and women.
Seeman E Pathogenesis of bone fragility in women and men. Augat P Schorlemmer S. The role of cortical bone and its microstructure in bone strength.
Age Ageing. Microindentation for in vivo measurement of bone tissue mechanical properties in humans. Dimensions and volumetric BMD of the proximal femur and their relation to age among older U. Seeman E. Periosteal bone formation—a neglected determinant of bone strength. N Engl J Med. Seeman E Delmas PD. Bone quality—the material and structural basis of bone strength and fragility.
Intracortical remodelling and porosity in the distal radius and post-mortem femurs of women: a cross-sectional study. Risk factors for falls among elderly persons living in the community. Is a fall just a fall: correlates of falling in healthy older persons.
J Am Geriatr Soc. Histories including number of falls may improve risk prediction for certain non-vertebral fractures in older men. Inj Prev. The epidemiology of falls and syncope.
Clin Geriatr Med. Falls as risk factors for fracture. Google Preview. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Wehren LE. The epidemiology of osteoporosis and fractures in geriatric medicine. Risk factors for injurious falls: a prospective study. J Gerontol. The increasing burden of pelvic fractures in older people, New South Wales, Australia.
Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. Risk factors for fractures of the distal forearm and proximal humerus. Falls leading to femoral neck fractures in lucid older people. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment.
J Orthop Trauma. Increased falling as a risk factor for fracture among older women: the study of osteoporotic fractures.
Predictors of ankle and foot fractures in older women. Facial fractures: a 1-year retrospective study in a hospital in Belo Horizonte. Braz Oral Res. Risk factors for fracture of the shafts of the tibia and fibula in older individuals.
A hypothesis: the causes of hip fractures. Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. For both genders, distal radius and proximal femur fractures are among the three most common fractures.
The age- and gender-specific incidence for suffering any type of fracture is shown in Fig 1. The overall fracture incidence was higher for men than for women until the age of 48 years, after which women had a higher fracture incidence.
Black line represents the total population; red line represents females and blue line represents males. The mean ages and the proportion of the fractures in individuals above 50, 65 and 75 years of age respectively for all different fracture locations for all registered patients, and for women and men separately, are given in Tables 3 , 4 and 5.
The five most common fracture locations showed large differences regarding mean age The mean age for fractures traditionally considered to be fragility fractures was above 63 years both genders combined.
Proximal femur fracture was the most closely associated with high age; Three of the four most common fracture locations seen in women over 50 years of age are traditionally considered to be fragility fractures distal radius, proximal femur, and proximal humerus fractures. For proximal tibia fractures, often considered to belong to the group of fragility fractures, the relation to high age was somewhat weaker with a high proportion, Similar proportions were seen for distal radius fractures, with The age distributions for the different fractures in men and women are given in Tables 4 and 5.
Overall, the mean age for the typical fragility fractures was higher in women than in men, and a larger proportion of these fractures also occurred in women. The proportions of fractures occurring at different ages showed similar frequencies in women over 50 years of age and in men over 65 years of age, suggesting a shift in age of about 15 years between sexes for fragility fractures. Seven groups were created, based on the graphical patterns for age- and gender-specific incidence.
The fracture incidence for the genders are displayed separately as well as the overall incidence in the graphs Fig 2A—2G. Since the incidence of the different fracture locations varied substantially, different scales for the different curves had to be used on the y-axis.
Proximal femur, acetabulum, spine, and distal humerus fractures belonged to this group Fig 2. Pelvis, femoral diaphysis, and distal femur fractures belonged to this group Fig 3. Women mostly accounted for the increase in incidence in this group. Proximal humerus, humeral diaphysis, proximal forearm, distal radius, proximal tibia, ankle, and patella fractures belonged to this group Fig 4.
Group D included fractures with a higher incidence in men of most ages; a higher or similar incidence in women was only seen in the very elderly. Scapula and clavicle fractures belonged to this group Fig 5.
Group E included fracture types with a higher incidence in men than in women until the age of approximately 50 years, after which there was a higher incidence in women. Tibia diaphysis, distal tibia, forearm, and finger phalanx fractures belonged to this group Fig 6. Group F included fractures with a peak in incidence around 50 years of age. For two of the fracture types, a bimodal appearance with a smaller peak in the youngest individuals around 20 years of age was seen.
Metatarsal, midfoot, and toe phalanx fractures belonged to this group Fig 7. Group G included fractures with the highest incidence observed in young men. In women, the curves were flat or gradually increased with age up to about 70 years. The carpal, metacarpal, talar, and calcaneal fractures belonged to this group, but calcaneal fractures showed a slightly different pattern Fig 8. The overall fracture incidence seen in the present study was 1, per , individuals per year and the most common fractures were located in the distal radius, proximal femur, ankle, proximal humerus, and metacarpal bones.
The grouping of fractures based on incidence patterns, regarding age and gender, was used to present at which locations fragility fractures mainly occurs. The incidence curves clearly showed that for many more fractures, than traditionally considered as fragility fractures, elderly individuals accounted for the majority of the fractures. This fits well with that most of the fractures were labelled as caused by low-energy trauma. Distal radius fractures was, as described in previous studies, found to be the most common fracture [ 5 , 19 , 23 , 37 ].
Interestingly the incidences for distal radius fractures in women were These cohorts were collected 20 years apart, however, and the similarity in incidence suggests a decline in radius fracture incidence in the older population, since there has been a known increase in the proportion of elderly in the western world during this time.
A true decline in radial fracture incidence for older individuals are however speculative based on the data from the present study. In a study by Dimai et al. However, differences in the data collection between the studies suggest that comparisons need to be interpreted with caution. The frequencies of femur fractures in the present study differ substantially from those in previous studies, probably because of differences in how the fractures were classified in the different studies.
Furthermore factors such as how the data on reported fractures were obtained collected in a register or collected from hospital databases , the uncertainty about completeness in different studies, and also the fact that many studies have used relative and not absolute incidence numbers adds to the difficulty in making comparisons between studies. However, the distributions of fracture incidence in relation to age in the present study are in overall agreement with other studies [ 19 , 23 , 38 ].
Clear differences in incidence were observed between men and women for almost all fracture locations in the present study. Another clear pattern was that higher incidences regarding most fractures were observed at younger ages for men than for women.
This probably reflects the fact that young men take higher risks and more often suffer high-energy trauma than young women. Overall, considering all ages and all fractures, the fracture incidence in women was higher than in men in the present study, driven by the higher incidence of osteoporotic fractures in women. An overall higher incidence in women was reported by Court-Brown et al. The overall fracture incidence of 1, per , individuals per year in the present study is close to the incidence reported by Court-Brown et al.
In the study by Driessen et al. This is markedly higher than in the present study. The inclusion age for the different studies above varied from over 12 years of age [ 23 ], to what might be considered a skeletally mature population, above the age of 16 years [ 5 ], to over 20 years [ 19 , 38 ]. Some authors have concentrated on the incidence for specific age groups; for example, in the study by Court-Brown from only patients over 35 years of age were included [ 37 ].
In the study by Beerkamp et al. The present study was inspired by previous work by Court-Brown and co-workers, who have published a number of studies on fracture incidence in the Edinburgh area [ 11 , 23 , 37 , 40 ]. In one of their papers, Court-Brown et al. The most common fractures in older adults are vertebral fracture from compression or trauma, followed by hip and distal radius fractures.
See Table 2. One in two women and one in five men will suffer from an osteoporotic fragility fracture, which is defined as any low-energy trauma fracture. The most common fragility fractures are proximal humerus, hip, distal radius, and spinal fractures.
Younger adults tend to have flexion-distraction fractures, while older adults suffer the higher mortality extension fractures. CT also aids in the assessment of fracture age and acuity. Acute fractures can be treated with analgesics only, or treated surgically with balloon kyphoplasty or vertebroplasty, which is best done in the first two months after an acute fracture.
Figure 1. Multiple Thoracic Spine Fractures. Figure 2. L1 Compression Fracture. Thoracic and lumbar compression fractures from low BMD or low-impact trauma are a significant health problem. ED referral or discussion with the patient about treatment options is also important, as most compression fractures will be treated on an outpatient basis unless there is uncontrollable pain or concern for cord injury.
Hip fractures fractures of the proximal femur, including subcapital neck, intertrochanteric, subtrochanteric, and others are some of the most common types of fragility fractures and are associated with the highest mortality.
The incidence of hip fractures worldwide may be decreasing slightly due to implementation of national screening guidelines and preventative treatment. Women more commonly suffer hip fractures at a rate of 4. The clinical presentation of hip fracture classically occurs after a fall in an older individual, but can present after any type of traumatic injury.
In most instances, a hip fracture can be diagnosed from the history and physical exam. Patients are usually unable to bear weight on the affected side, have tenderness to palpation over the greater trochanter, and pain with external rotation, abduction, or axial loading of the hip. More obvious fractures will present with the leg in external rotation and shortened. Currently, MRI is the gold standard for the detection of occult fractures and should be considered in any at-risk patient unable to bear weight after a traumatic event.
Figure 3. Hip Fracture. Treatment strategies include various surgical options. It is important to optimize pre-operative health, but delays in surgery have been shown to increase mortality.
Those at highest risk of mortality and complications include patients on dialysis, those presenting in shock, patients with obesity, history of cardiopulmonary disease, diabetes, or a delay to surgery of more than 48 hours. The emergency physician can decrease morbidity and mortality by having a low threshold to proceed to CT or MRI to rule out occult fracture, facilitating pre-operative clearance decreasing time to surgery , and discussing delirium and pressure ulcer prevention with family and staff.
Depending on the anesthesia and hospitalist staff, pre-operative clearance usually involves a pulmonary exam and chest X-ray, a cardiac exam with EKG and possibly echocardiogram if the patient has a history of heart failure or valve disorders, and a medication review.
Pre-operative labs such as a type and cross, coagulation parameters PT and PTT , and basic blood counts and chemistries are also required. Many of these tests can be obtained quickly in the ED. Cervical spine c-spine injury see Figures 4 and 5 is a significant cause of morbidity and mortality in the geriatric trauma patient.
Rollover motor vehicle accidents and older age increase the risk of c-spine fracture. Due to the decreased range of motion of the cervical spine, elderly patients are more likely to sustain higher level c-spine fractures see Figures 6 and 7 , while younger patients are more likely to sustain lower c-spine injury. Elderly patients are also more likely to have additional intracranial injuries compared to younger patients.
Figure 4. Cervical Spine Fracture. Figure 5. Figure 6. C1 Fracture. Figure 7. C2 Fracture. You can prevent hip fractures by taking steps to strengthen your bones and prevent falls:.
Talk to Your Doctor Ask your doctor or healthcare provider to evaluate your risk for falling and talk with them about specific things you can do.
Ask your doctor or pharmacist to review your medicines to see if any might make you dizzy or sleepy. This should include prescription medicines and over-the counter medicines.
Ask your doctor or healthcare provider about taking vitamin D supplements. Get Screened for Osteoporosis Get screened for osteoporosis and treated if needed. Do Strength and Balance Exercises Do exercises that make your legs stronger and improve your balance. Have Your Eyes Checked Have your eyes checked by an eye doctor at least once a year, and be sure to update your eyeglasses if needed.
Make Your Home Safer Get rid of things you could trip over.
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