Fragility Fractures And Osteoporosis

Main Category: Bones / Orthopaedics
Article Date: 05 Jun 2009 - 1:00 PDT

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Low energy fractures of the proximal humerus indicate osteoporosis and it is important to direct treatment in order to prevent further fractures. Therefore, in this study the authors collected data from 79 patients with fractures of the proximal humerus in order to determine if current guidelines on measurement of bone mineral density at the hip and lumbar spine were adequate to stratify the risk and to guide the treatment of osteoporosis.

The World Health Organisation defines osteoporosis by comparing the bone mineral density with that of a gender-matched, healthy young adult reference population. A T-score in women of less than -2.5 at any one of three skeletal sites, the femur, the lumbar spine or the distal radius is the WHO 'gold standard' for diagnosing osteoporosis. However, the most common clinical method for assessing the BMD is dual-energy x-ray absorbtiometry of the central skeleton taken at the hip and lumbar spine. Therefore, the authors decided to analyse the sensitivity of these sites and the distal radius in diagnosing osteoporosis in accordance with WHO criteria.

The results show that 'there is a wide variation in the BMD when measured at different skeletal sites' and that when considering injuries to the upper limb, the BMD measured at the distal radius may represent the risk of osteoporotic humeral fractures better than that measured at the axial skeleton or lower limbs. This is because the distal radius has a large proportion of cancellous bone which is affected to a greater extent by age-related changes in the BMD. Therefore, the authors conclude that 'measurement of the BMD at the hip and lumbar spine, if used alone, may underestimate the risk of osteoporosis in the upper limb' and that measurement of the BMD at the radius should not be omitted when osteoporosis is being investigated.

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Source
The Journal of Bone and Joint Surgery