Osteoporosis is a serious chronic disease that affects approximately 55% of people in the U.S. over the age of 60. Many of these people may not know they have the disease until they suffer a fracture of some kind. The most common types of osteoporosis fractures in patients are fractures of the hip and vertebrae, but any bone has the potential to be fractured when it is brittle and weakened by osteoporosis.
Of course there are risks associated with osteoporosis fractures in the elderly, not the least of which is pain and an increased risk of re-fracture, but until recently much of the focus has been on hip and vertebral fractures. A new study from Associate Professor Jackie Center and Dr. Dana Bliuc of the Garvan Institute of Medical Research indicates that non-hip and non-vertebral fracture may carry more serious risks than previously thought. The results of the research study were published in the November 2013 issue of the Journal of Clinical Endocrinology and Metabolism.
Center and Bliuc looked at data from the Dubbo Osteoporosis Epidemiology Study. This study is the longest running, large-scale study epidemiological study of bone fractures due to osteoporosis. They analyzed data for all types of fractures in people over 60 and determined the risk of premature death as a result of each type of osteoporosis fracture. They also looked at the risk for re-fracture and premature death after that re-fracture.
Hip fractures were found to be most serious and most likely to cause premature death, with vertebral fractures following close behind.
Proximal fractures, those fractures that occur in the ribs or pelvis, can be as serious as hip fractures, including having the potential to cause premature death. Of fractures, distal fractures are least likely to cause premature death. These typically occur at points farthest away from the body, such as the ankles or wrists. With distal fractures, there is a high potential for re-fracture, with a greatly increased healing time and an increased risk for premature death.
The researchers developed a “competing risk model” to evaluate the risk of premature death after an initial fracture, and again after a 2nd fracture.
Dr Dana Bliuc describes their model and the potential outcomes:
“The competing risk model can have 3 outcomes–mortality following the initial fracture, risk of re-fracture, and risk of mortality following re-fracture. When we looked at mortality following the initial fracture, we observed that it is very high for all fracture types for the first 5 years following fracture. It then declines towards the general population mortality risk.”
Overall, the risk went up with a 2nd fracture, with men much more vulnerable than women. 80-90% of men experienced premature death as a result of a 2nd fracture after an initial hip fracture.
People over 75 who had a 2nd fracture had a similar risk of premature death, regardless of where the first osteoporosis fracture occurred.
Another study presented at the 4th Asia-Pacific Osteoporosis Meeting adds to this research in looking at risks related to 2nd fracture.
Focusing specifically on re-fracture of the hip, this study looked at 43,832 patients over 65 (median age of 83.7) with a hip fracture. The ratio of male to female participants was 3:7, and of those patients 2,399 2nd hip fractures were studied.
75% of hip fractures occurred within 4 years of the first fracture, and the average length of time between 1st and 2nd osteoporosis fracture was 2 years and 8 months.
After the 2nd fracture, median survival rate was 3 years and 8 months, compared with 4 years and 10 months after a single fracture, with males having lower survival rates after a 2nd fracture. Older patients did not see a significant increase in mortality after a 2nd fracture.
So what is the significance of the increased risk of mortality after osteoporosis fractures?
Because many people with osteoporosis will suffer a fracture in their lifetime, this puts them at more risk of premature mortality. Endocrinologist and researcher Jackie Center says:
“Fractures impose an enormous health burden, even with minimal hospitalization, and significantly impair the lives of patients and their families. The faster we act to reduce the risk of re-fracture, the better it will be for everyone.”
Even distal fractures that are seen as less threatening put patients with osteoporosis at risk of re-fracture.
Researchers T.-L. Huang and C.-W. Chen from the China Medical University in Chinese Taipei presented their findings in a study on the risk of hip fracture after Colles’ fracture at the IOF Regionals 4th Asia-Pacific Osteoporosis Meeting in Hong Kong. Looking specifically at patients who had suffered a wrist fracture, they found that the risk of hip fracture rose 6 times after patients suffered this type of fracture. Study participants were most likely to suffer a hip fracture within a month of their Colles’ fracture, and osteoporosis patients were in particular danger of fracture.
The risk of osteoporosis fracture goes beyond suffering the pain and inconvenience of the fracture itself. It is important to work to build strength and practice preventative care before suffering a fracture. If a patient does suffer an osteoporosis fracture, proper treatment and care is crucial to prevent re-fracture in the 5 years following, when patient mortality achieves approximately the same level as the general population.
Have you or someone in your life suffered a fracture due to osteoporosis? What was the outcome?
Image by Rev Stan via Flickr