Skip to main content

Advertisement

Log in

Determinants of fracture risk in osteoporosis

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Osteoporosis is a major public health issue, with fragility fractures of the hip, vertebrae, and distal radius considered the most important consequences. These lead to increased morbidity, mortality, hospital care, and dependency. The risk factors for the development of fragility fractures are numerous and involve genetic and environmental influences, as well as an interaction between the two. In this review, the recent literature examining genetic factors, possible candidate genes, the evolving area of intrauterine fetal programming, and anthropometric and environmental factors will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Melton L, Cooper C: Magnitude and impact of osteoporosis and fractures. In In Osteoporosis, edn 2. Edited by Marcus R, Feldman D, Kelsey J. San Diego: Academic Press Inc; 2001:557–567.

    Google Scholar 

  2. Hunter D, de Lange M, Andrew T, et al.: Genetic variation in bone mineral density and calcaneal ultrasound: a study of the influence of menopause using female twins. Osteoporos Int 2001, 12:406–411. A good review.

    Article  PubMed  CAS  Google Scholar 

  3. Kannus P, Palvanen M, Kaprio J, et al.: Genetic factors and osteoporotic fractures in elderly people: prospective 25 year follow-up of a nationwide cohort of elderly Finnish twins. BMJ 1999, 319:1334–1337. A large, long-term study indicating no increased concordance for fractures between monozygotic compared with dizygotic twins.

    PubMed  CAS  Google Scholar 

  4. Ma X, Jing Y, Qin W, et al.: Vitamin D receptor gene polymorphism and bone mineral density in patients with type 2 diabetes mellitus. Chin Med J 2001, 114:1213–1215.

    PubMed  CAS  Google Scholar 

  5. Pares A, Guanabens N, Alvarez L, et al.: Collagen type I alpha 1 and vitamin D receptor gene polymorphisms and bone mass in primary biliary cirrhosis. Hepatology 2001, 33:554–560.

    Article  PubMed  CAS  Google Scholar 

  6. Vogelsang H, Suk E, Janisiw M, et al.: Calcaneal ultrasound attenuation and vitamin D receptor genotypes in celiac disease. Scand J Gastroenterol 2000, 35:172–176.

    Article  PubMed  CAS  Google Scholar 

  7. Langdahl B, Gravholt C, Brixen K, Eriksen E: Polymorphisms in the vitamin D receptor gene and bone mass, bone turnover and osteoporotic fractures. Eur J Clin Invest 2000, 30:608–617.

    Article  PubMed  CAS  Google Scholar 

  8. Dennison E, Arden N, Keen R, et al.: Birthweight, vitamin D receptor genotype and the programming of osteoporosis. Pediatr Perinatal Epidemiol 2001, 15:211–219. Further evidence of genetic-environmental interaction.

    Article  CAS  Google Scholar 

  9. Hustmyer F, Liu G, Johnston C, et al.: Polymorphism at an Sp1 binding site of COL1A1 and bone mineral density in premenopausal female twins and elderly fracture patients. Osteoporos Int 1999, 9:346–350.

    Article  PubMed  CAS  Google Scholar 

  10. Keen R, Woodford-Richens K, Grant S, et al.: Association of polymorphism at the type I collagen (COL1A1) locus with reduced bone mineral density, increased fracture risk, and increased collagen turnover. Arthritis Rheum 1999, 42:285–290.

    Article  PubMed  CAS  Google Scholar 

  11. Sainz J, Van Tornout J, Sayre J, et al.: Association of collagen type 1 alpha 1 gene polymorphism with bone density in early childhood. J Clin Endocrinol Metab 1999, 84:853–855.

    Article  PubMed  CAS  Google Scholar 

  12. Brown M, Haughton M, Grant S, et al.: Genetic control of bone density and turnover: role of collagen 1 alpha 1, estrogen receptor, and vitamin D receptor genes. J Bone Miner Res 2001, 16:758–764. A twin study showing an interaction between genetic polymorphisms, calcium intake, and BMD.

    Article  PubMed  CAS  Google Scholar 

  13. Takacs I, Koller D, Peacock M, et al.: Sibling pair linkage and association studies between bone mineral density and the insulin-like growth factor I gene locus. J Clin Endocrinol Metab 1999, 84:4465–4466.

    Article  Google Scholar 

  14. Wuster C, Abs R, Bengtsson B, et al.: The influence of growth hormone deficiency, growth hormone replacement therapy, and other aspects of hypopituitarism on fracture rate and bone mineral density. J Bone Miner Res 2001, 16:398–405.

    Article  PubMed  CAS  Google Scholar 

  15. Scheidt-Nave C, Bismar H, Leidig-Bruckner G, et al.: Serum interleukin-6 is a major predictor of bone loss in women specific to the first decade past menopause [abstract]. J Bone Miner Res 1999, 14(suppl):S147.

    Google Scholar 

  16. Ferrari S, Garnero P, Edmond S, et al.: A functional polymorphic variant in the interleukin-6 gene promoter associated with low bone resorption in postmenopausal women. Arthritis Rheum 2001, 44:196–201.

    Article  PubMed  CAS  Google Scholar 

  17. Keen R, Sneider H, Molloy H, et al.: Evidence of association and linkage dysequilibrium between a novel polymorphism in the transforming growth factor beta 1 gene and hip bone mineral density: a study of female twins. Rheumatology 2001, 40:48–54.

    Article  PubMed  CAS  Google Scholar 

  18. Gong Y, Slee R, Fukai N, et al.: LDL receptor-related protein 5 (LRP5) affects bone accrual and eye development. Cell 2001, 107:513–523.

    Article  PubMed  CAS  Google Scholar 

  19. Boyden L, Junhao M, Belsky J, et al.: High bone density due to a mutation in LDL-receptor-related protein 5. N Engl J Med 2002, 346:1513–1521.

    Article  PubMed  CAS  Google Scholar 

  20. Cooper C, Javaid M, Taylor P, et al.: The fetal origins of osteoporotic fracture. Calcif Tissue Int 2002, 70:391–394.

    Article  PubMed  CAS  Google Scholar 

  21. Sayer A, Dunn R, Langley-Evans S, Cooper C: Prenatal exposure to a maternal low protein diet shortens life span in rats. Gerontology 2001, 47:9–14.

    Article  Google Scholar 

  22. Gale C, Martyn C, Kellingray S, et al.: Intrauterine programming of adult body composition. J Clin Endocrinol Metab 2001, 86:267–272. An elegant study showing an association between birth weight and adult bone mineral content.

    Article  PubMed  CAS  Google Scholar 

  23. Dennison E, Hindmarsh P, Fall C, et al.: Profiles of endogenous circulating cortisol and bone mineral density in healthy elderly men. J Clin Endocrinol Metab 1999, 84:3058–3063.

    Article  PubMed  CAS  Google Scholar 

  24. Godfrey K, Walker-Bone K, Robinson S, et al.: Neonatal bone mass: influence of parental birthweight, maternal smoking, body composition and activity during pregnancy. J Bone Miner Res 2001, 16:1694–1703. Well-designed study showing the effect of maternal factors on neonatal bone mass.

    Article  PubMed  CAS  Google Scholar 

  25. Cooper C, Eriksson J, Forsen T, et al.: Maternal height, childhood growth and risk of hip fracture in later life: a longitudinal study. Osteoporos Int 2001, 12:623–629. Convincing evidence for the influence of maternal and childhood influences on adult fracture risk.

    Article  PubMed  CAS  Google Scholar 

  26. Javaid M, Godfrey K, Taylor P, et al.: Umbilical cord IGF-1 predicts neonatal bone and fat mass [abstract]. British Society for Rheumatology XIXth Annual General Meeting 2002. Rheumatology 2002, 41(suppl):5.

    Article  Google Scholar 

  27. Arden N, Dennison E, Syddall H, et al.: Early life influences on serum 1,25(OH)2 vitamin D [abstract]. British Society for Rheumatology XIXth Annual General Meeting 2002. Rheumatology 2002, 41(suppl):5.

    Article  Google Scholar 

  28. Phillips D, Fall C, Cooper C, et al.: Size at birth and plasma leptin concentrations in adult life. Int J Obesity 1999, 23:1025–1029.

    Article  CAS  Google Scholar 

  29. Dennison E, Fall C, Syddall H, et al.: Plasma leptin concentration is associated with bone mass in healthy elderly men and women. [abstract] British Society for Rheumatology XIXth Annual General Meeting 2002. Rheumatology 2002, 41(suppl)1:97.

    Google Scholar 

  30. Roy D, Armbrecht G, Finn J, Felsenberg D, Lunt M, O’Neill T, Cooper C, Reeve J, Silman A: The influence of reproductive and lifestyle factors on the risk of incident vertebral fracture in women: results from the European Prospective Osteoporosis Study (EPOS) [abstract]. British Society for Rheumatology XIXth Annual General Meeting 2002. Rheumatology 2002, 41(suppl)1:6.

    Google Scholar 

  31. Scoutellas V, O’Neill T, Lunt M, et al.: Does the presence of postmenopausal symptoms influence susceptibility to vertebral deformity? European Vertebral Osteoporosis Study (EVOS) Group. Maturitas 1999, 32:179–187.

    Article  PubMed  CAS  Google Scholar 

  32. Ismail A, Cockerill W, Cooper C, et al.: Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 2001, 12:85–90. Large epidemiologic study showing increased risk of hip fracture with prevalent vertebral fracture.

    Article  PubMed  CAS  Google Scholar 

  33. Ismail A, O’Neill T, Cooper C, Silman A: Risk factors for vertebral deformities in men: relationship to number of vertebral deformities. European Vertebral Osteoporosis Study Group. J Bone Miner Res 2000, 15:278–283.

    Article  PubMed  CAS  Google Scholar 

  34. Lunt M, O’Neill T, Armbrecht G, et al.: Characteristics of prevalent vertebral deformity and the risk of incident vertebral fracture [abstract]. British Society for Rheumatology XIXth Annual General Meeting 2002. Rheumatology 2002, 41(suppl):101–102.

    Google Scholar 

  35. Lindsay R, Silverman S, Cooper C, et al.: Risk of new vertebral fracture in the year following a fracture. JAMA 2001, 285:320–323.

    Article  PubMed  CAS  Google Scholar 

  36. Cornuz J, Fesknich D, Willett W, Colditz G: Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 1999, 106:311–314.

    Article  PubMed  CAS  Google Scholar 

  37. Bjarnason N, Christiansen C: The influences of thinness and smoking on bone loss and response to hormone replacement therapy in early postmenopausal women. J Clin Endocrinol Metab 2000, 85:590–596.

    Article  PubMed  CAS  Google Scholar 

  38. Hoidrup S, Gronbaek M, Pederson A, et al.: Hormone replacement therapy and hip fracture risk: effect modification by tobacco smoking, alcohol intake, physical activity, and body mass index. Am J Epidemiol 1999, 150:1085–1093.

    PubMed  CAS  Google Scholar 

  39. Chapurlat R, Ewing S, Bauer D, Cummings S: Influence of smoking on the antiosteoporotic efficacy of raloxifene. J Clin Endocrinol Metab 2001, 86:4178–4182.

    Article  PubMed  CAS  Google Scholar 

  40. Sulzc P, Garnero P, Claustrat B, et al.: Increased bone resorption in moderate smokers with low body weight: the Minos study. J Clin Endocrinol Metab 2002, 87:666–674.

    Article  Google Scholar 

  41. Liu X, Zhu Y, Umino T, et al.: Cigarette smoke inhibits osteogenic differentiation and proliferation of human osteoprogenitor cells in monolayer and three-dimensional collagen gel culture. J Lab Clin Med 2001, 137:208–219.

    Article  PubMed  CAS  Google Scholar 

  42. Rapuri P, Gallagher J, Balhorn K, Ryschon K: Alcohol intake and bone metabolism in elderly women. Am J Clin Nutr 2000, 72:1206–1213.

    PubMed  CAS  Google Scholar 

  43. Hoidrup S, Gronbaek M, Gottschau A, et al.: Alcohol intake, beverage preference, and risk of hip fracture in men and women: Copenhagen Center for Prospective Population Studies. Am J Epidemiol 1999, 149:993–1001. Clinically important evidence that excess alcohol increases risk of fracture.

    PubMed  CAS  Google Scholar 

  44. Van Staa T, Leufkens H, Abenhaim L, et al.: Use of oral corticosteroids in the United Kingdom. Q J Med 2000, 93:105–111.

    Google Scholar 

  45. Van Staa T, Leufkens H, Abenhaim L, et al.: Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000, 15:993–1000. Clinically important data regarding the use of corticosteroids.

    Article  PubMed  Google Scholar 

  46. Selby P, Halsey J, Adams K, et al.: Corticosteroids do not alter the threshold for vertebral fracture. J Bone Miner Res 2000, 15:952–956.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Harvey, N., Cooper, C. Determinants of fracture risk in osteoporosis. Curr Rheumatol Rep 5, 75–81 (2003). https://doi.org/10.1007/s11926-003-0086-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-003-0086-5

Keywords

Navigation