Contrary to a widely held assumption, high-trauma nonspine fractures in older women and men, such as from a car crash, are associated with low bone mineral density and an increased risk of a subsequent fracture, according to a study in the November 28 issue of JAMA.
These findings suggest that older adults who experience these fractures should be evaluated for osteoporosis.
“… it is widely believed, without supporting evidence, that high-trauma fractures [those resulting from motor vehicle crashes or falls from greater than standing height] are not related to low bone mineral density (BMD) or subsequent fracture risk and therefore are presumed not to be manifestations of osteoporosis,” the authors write. They add that these beliefs have several consequences, including the clinical opinions that an older adult who has a high-trauma fracture does not require evaluation for osteoporosis, and that high-trauma fractures cannot be prevented by osteoporosis treatments that increase BMD and bone strength.
Dawn C. Mackey, M.Sc., of the San Francisco Coordinating Center, San Francisco, and colleagues examined the association between BMD in older adults and risk of high-trauma fracture and the association between this type of fracture and risk of a subsequent fracture. The researchers analyzed data from two U.S. studies of adults 65 years or older from geographically diverse areas. The Study of Osteoporotic Fractures followed-up 8,022 women for 9.1 years (1988-2006), and the Osteoporotic Fractures in Men Study followed-up 5,995 men for 5.1 years (2000-2007).
Hip and spine BMD were assessed by dual-energy x-ray absorptiometry (an imaging technique). New nonspine fractures were confirmed by x-ray. Fractures were classified as high trauma or as low trauma (due to falls from standing height and less severe trauma). Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3,211 women and 346 men sustained an initial low-trauma fracture.