risk of fracture
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Etiology
- osteopenia
- osteoporosis
- year prior to a cancer diagnosis[9]
- risk continues to rise 1-5 years after cancer diagnosis
- multiple myeloma
- bone metastases
- post-menopausal weight gain or weight loss (> 5%) is associated with increased risk of bone fracture atmost, but not all sites[1]
- unintentional weight loss associated with highest risk of fracture, hip fracture (RR=1.33), vertebral fracture (RR=1.33)
- initiation of antihypertensive in nursing home associated with increased risk of falls & fractures[6]
- risk higher among residents with dementia, higher baseline blood pressure & no recent antihypertensive use[6]
- men with lower sex hormone-binding globulin (SHBG) in serum may have a lower risk of fracture than those with higher levels[7]
- fractures at any age in adulthood, linked to fracture risk in older adults[8]
Diagnostic procedures
- USPSTF recommends screening for osteoporosis in all women >= 65 years & in women < 65 years who at increased risk for osteoporosis, as determined by a formal clinical risk assessment tool (FRAX & QFracture are two such tools)
- FRAX fracture risk assessment tool (fee) for use in older patients uses results of DEXA scan if available in addition to clinical factors
- QFracture risk calculator is free
Radiology
- DEXA scan as indicated by FRAX fracture risk assessment tool
- include distal 3rd of radius in patients with hyperparathyroidism[5]
Management
- calcium supplements &/or dietary calcium do not significantly* increase bone mineral density or reduce risk of fractures in persons > 50 years of age[2]
- calcium supplements &/or vitamin D does not reduce fracture risk in community-dwelling older adults[3]
- small benefit for vitamin D & calcium together[4]
- vitamin D alone of no benefit[4]
* clinical significance vs statistical significance; 1-2% increase in bone mineral density not clinically significant[2]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Crandall CJ et al. Postmenopausal weight change and incidence of fracture: Post hoc findings from Women's Health Initiative observational study and clinical trials. BMJ 2015 Jan 27; 350:h25 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25627698 <Internet> http://www.bmj.com/content/350/bmj.h25
- ↑ 2.0 2.1 2.2 Tai V et al Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ 2015;351:h4183 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26420598 <Internet> http://www.bmj.com/content/351/bmj.h4183
Bolland MJ et al Calcium intake and risk of fracture: systematic review. BMJ 2015;351:h4580 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26420387 <Internet> http://www.bmj.com/content/351/bmj.h4580
Michaelsson K Calcium supplements do not prevent fractures. BMJ 2015;351:h4825 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26420735 <Internet> http://www.bmj.com/content/351/bmj.h4825 - ↑ 3.0 3.1 Zhao JG, Zeng XT, Wang J et al Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults. A Systematic Review and Meta-analysis. JAMA. 2017;318(24):2466-2482 PMID: https://pubmed.ncbi.nlm.nih.gov/29279934 https://jamanetwork.com/journals/jama/article-abstract/2667071
- ↑ 4.0 4.1 4.2 Yao P, Bennett D, Mafham M, et al. Vitamin D and calcium for the prevention of fracture: A systematic review and meta-analysis. JAMA Netw Open 2019 Dec 2; 2:e1917789 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757873
- ↑ 5.0 5.1 NEJM Knowledge+ Endocrinology
- ↑ 6.0 6.1 6.2 Dave CV et al. Antihypertensive medication and fracture risk in older Veterans Health Administration nursing home residents. JAMA Intern Med 2024 Apr 22; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/38648065 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818019
- ↑ 7.0 7.1 Grahnemo L, Marriott RJ, Murray K et al Associations of Serum Testosterone and Sex Hormone-Binding Globulin with Incident Fractures in Middle-Aged to Older Men. J Clin Endocrinol Metab. 2024 Oct 7:dgae703. PMID: https://pubmed.ncbi.nlm.nih.gov/39373573 https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgae703/7814739
- ↑ 8.0 8.1 Ye C, Morin SN, Lix LM et al Age at First Fracture and Later Fracture Risk in Older Adults Undergoing Osteoporosis Assessment. JAMA Netw Open. 2024 Dec 2;7(12):e2448208. PMID: https://pubmed.ncbi.nlm.nih.gov/39621347 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827189
- ↑ 9.0 9.1 Ye C, Leslie WD, Al-Azazi S, et al A Population-Based Cohort Study of Fracture Risk Among 122,255 Adults Before and After Cancer Diagnosis Compared with Matched Controls. J Bone Miner Res. 2026 Mar 10:zjag048. doi:http://dx.doi.org/ 10.1093/jbmr/zjag048. Online ahead of print. PMID: https://pubmed.ncbi.nlm.nih.gov/41804783 https://doi.org/10.1093/jbmr/zjag048