Breaking Away From Osteoporosis

Main Category: Bones / Orthopaedics
Article Date: 14 Mar 2008 - 1:00 PST

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Although osteoporosis contributes to an estimated 1.5 million bone fractures yearly, the correlation may not be as significant as we think, according to a study published in the February 2008 issue of the Journal of Bone and Joint Surgery (JBJS).

True, osteoporosis is a degenerative bone disease that affects 28 million Americans, often developing unnoticed for many years with no symptoms or discomfort until a fracture occurs. However, the study found that other bone- and fall-related risk factors also were important complementary indicators of fracture risk. Those who have sustained a previous fracture after the age of 50 or have a history of fractures and/or who weigh less than 132 pounds accounted for the majority of bone-related risk factors, whereas fall-related risk factors increased with the following factors:

- Impaired vision
- Joint problems
- Low levels of daily activity before fracture
- More than one fall in the previous year
- Urinary incontinence
- Use of psychoactive drugs

The American Academy of Orthopaedic Surgeons (AAOS) identifies similar risk factors in its guidelines. Yet both sets of guidelines differ from those currently followed in the Netherlands, where the study was conducted and against whose standards the study was assessed. In fact, the study finds Dutch guidelines-and any other guidelines that do not fully consider bone- and fall-related risk factors (the World Health Organization's included)-insufficient for preventing a first fracture.

Researchers reviewed the cases of more than 500 patients over age 50 who had suffered a bone fracture. What they found was few patients (35 percent) had osteoporosis, while 53 percent had at least one other bone-related risk factor and 75 percent had at least one fall-related risk factor. Many were afflicted with a combination of risk factors, regardless of their age, gender and fracture location. These results underscore the importance of examining other risk factors in the treatment of fracture patients.

"Looking only at osteoporosis is not enough," concluded Svenhjalmar van Helden, MD, one of the study's authors. Dr. van Helden is a trauma surgeon in the Department of General Surgery and Trauma Surgery at University Hospital Maastricht in the Netherlands.

"Patients above the age of 50 with a previous fracture should work together with their physician to prevent future fractures. The patient and physician need to assess the future fracture risk and actively participate together to decrease those risks. A risk assessment program with bone-density scan and diagnosis of other bone- and fall-related risk factors should be performed.

"Additionally, orthopaedic surgeons need to look beyond the fracture," van Helden continued. "Every fracture patient above the age of 50 would benefit from assessment to assess the absolute fracture risk."

Disclosure: Dr. van Helden and his colleagues received partial funding for this study from Merck Sharp & Dohme. In addition, Procter & Gamble agreed to provide funding to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

American Academy of Orthopaedic Surgeons