Abstract
Summary
Screening in a standardized manner for osteoporosis in non-vertebral fracture patients aged 50 and older independently of both gender and level of trauma energy yielded the indication for osteoporotic therapy for every fourth male high-energy fracture patient.
Purpose
This study aimed to identify the rate of osteoporosis in patients of both genders after fracture independently of the underlying level of trauma energy.
Methods
A random cohort of patients aged 50 or older with non-vertebral fractures participated in a standardized diagnostic protocol to evaluate the indication for treatment of osteoporosis (number needed to screen (NNS)). Univariate and multivariate analysis as well as correlation testing were performed to determine statistical relationships. Significance was set at p < 0.05.
Results
Of 478 fracture patients with a mean age of 69.3 ± 11.8 years, 317 (66.3%) were female and 161 (33.7%) male. One hundred nineteen patients (24.9%) sustained high-energy fractures (HEFs) and 359 (75.1%) low-energy fractures (LEFs). Twenty-eight percent of males and 47% of females qualified as osteoporotic in densitometry (dual-energy X-ray absorptiometry (DXA)), resulting in a NNS of 2.1 for women and 3.6 for men. The indication for treatment of osteoporosis increased to an NNS of 1.5 for females and 2.4 for males if the fracture risk assessment tool (FRAX) was included in the diagnostics (DXA and FRAX). With regard to the energy of trauma, the NNS for treatment following DXA and FRAX was 1.5 for LEF and 2.9 for HEF. Subgroup analysis revealed that HEF males within the decennia 50+ and 80+ had an NNS of around 3, i.e., comparable to females and about twice as high as LEF patients.
Conclusions
These preliminary findings appear to confirm the pragmatic approach to screening in a standardized manner for osteoporosis in all non-vertebral fracture patients aged 50 and older—independently of both gender and level of trauma energy.
Similar content being viewed by others
References
Jeray K (2015) Osteoporosis and fragility fractures. What progress have we made? J Bone Joint Surg Am 97:1553–1554
Neuerburg C, Stumpf U, Schmidmaier R, Kammerlander C, Pfeilschifter J, Mutscher W, Böcker W (2015) New DVO guideline for ostoeporosis management 2014 and its importance for trauma surgeons. Unfallchirurg 118:905–912
Bouillon R, Burckhardt P, Christiansen C et al (1991) Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 90:107–110
Lippuner K (2009) Epidemiology of osteoporotic fractures in Switzerland. Revue Médicale Suisse 5:1304–1308
Svedbom A, Ivergard M, Hernlund E, Rizzoli R, Kanis J (2014) Epidemiology and economic burden of osteoporosis in Switzerland. Arch Osteoporos 9:186–187 (1–8)
Burge R, Dawson-Hughes B, Solomon D, Wong J, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475
Ahmed L, Center J, Bjoernerem A, Bluic D, Joakimsen R, Joergensen L, Meyer H, Nguyen N, Nguyen T, Omsland T, Stoermer J, Tell G, van Geel T, Eisman J, Emaus N (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsoe study. J Bone Miner Res 28:2214–2221
Mackey D, Lui L-Y, Cawthon P, Bauer D, Nevitt M, Cauley JA, Hillier T, Lewis C, Barrett-Connor E, Cummings S (2007) High trauma fractures and low bone mineral density in older women and men. JAMA 298:2381–2388
Sanders K, Pasco J, Ugoni A, Nicholson G, Seeman E, Martin T, Skoric B, Panahi S, Kotowicz M (1998) The exclusion of high trauma fractures may undererstimate the prevalence of bone fragility fractures in the community: the Geelon osteoporosis study. J Bone Miner Res 13:1337–1342
Dirschl D (2014) Shame on us! Men need osteoporsis care, too! J Bone Joint Surg Am 96:e186
Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J, Eisman J (1993) Prediction of osteoporotic fractures by postural instability and bone density. BMJ 307:1111–1115
Lippuner K, von Overbeck J, Perretta L, Bosshard H, Jaeger P (1997) Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporos Int 7:414–425
DVO (2014) [Prophylaxis, diagnostics and therapy of osteoporosis]. www.dv-osteologie.org/dvo_leitlinien/osteoporose-leitlinie-2014
SVGO (2015) [Osteoporosis recommendations 2015—diagnostics, prevention, therapy]. www.svgo.ch
Cosman F, de Beur S, Lewiecki E, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381
Kanis J, the WHO study group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 4:368–381
Charlson M, Charlson R, Peterson J, Marinopoulos S, Briggs W, Hollenberg J (2008) The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 61:1234–1240
Charlson M, Szatrowski T, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251
Warriner A, Patkar N, Yun H, Delzell E (2011) Minor, major, low-trauma, and high-trauma fractures: what are the subsequent fracture risks and how do they vary? Curr Osteoporos Rep 9:122–128
Huisa B, Stemer A, Zivin J (2010) Atorvastatin in stroke: a review of SPARCL and subgroup analysis. Vasc Health Risk Manag 6:229–236
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey E, Jönsson B, Kanis J (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136
National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation 1:1–55
Lofthus C, Osnes E, Meyer H, Kristiansen I, Nordsletten L, Falch J (2006) Young patients with hip fracture: a population-based study of bone mass and risk factors for osteoporosis. Osteoporos Int 17:1666–1672
Hedlund R, Lindgren U (1987) Trauma type, age, and gender as determinants of hip fracture. J Orthop Res 5:242–246
Robinovitch S, Hayes W, McMahon T (1991) Prediction of femoral impact forces in falls on the hip. J Biomech Eng 113:366–374
Chiu J, Robinovitch S (1998) Predicition of upper extremitiy impact forces during falls on the outstretched hand. J Biomech 31:1169–1176
Choi W, Cripton P, Robinovitch S (2015) Effects of hip abductor muscle forces and knee boundary conditions on femoral neck stresses during simulated falls. Osteoporos Int 26:291–301
Mackey D, Black D, Bauer D, McCloskey E, Eastell R, Mesenbrink P, Thompson J, Cummings S (2011) Effects of antiresorptive treatment on nonvertebral fracture outcomes. J Bone Miner Res 26:2411–2418
Szulc P, Munoz F, Duboeuf F, Marchand F, Delmas P (2005) Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study. Osteoporos Int 16:1184–1192
Mussolino M, Looker A, Madans J, Langlois J, Orwoll E (1998) Risk factors for fip fracture in white men: the NHANES I epidemiologic follow-up study. J Bone Miner Res 13:918–924
Kanis J, McCloskey E, Johansson H, Cooper C, Rizzoli R, Reginster J-Y, ESCEO, IOF (2012) European guidance for diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57
Kanis J, Harvey N, Cooper C, Johansson H, Odén A, McCloskey E (2016) A systematic review of intervention thresholds based on FRAX. Arch Osteoporos 11:25
Frost M, Gudex C, Rubin K, Brixen K, Abrahamsen B (2012) Pattern of the use of DXA scans in men: a cross sectional population-based study. Osteoporos Int 23:183–191
Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141
Balasubramanian A, Tosi L, Lane J, Dirschl D, Ho P, O’Malley C (2014) Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009. J Bone Joint Surg Am 96:e52
Harper C, Fitzpatrick S, Zurakowski D, Rozental T (2014) Distal radial fractures in older men. J Bone Joint Surg Am 96:1820–1827
Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi J (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305
Leslie W, Giangregorio L, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix L (2012) A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving. Osteoporos Int 23:1623–1629
Edwards B, Koval K, Bunta A, Genuario K, Hahr A, Andruszyn L, Williams M (2011) Adressing secondary prevention of osteoporosis in fracture care: follow-up to “own the bone”. J Bone Joint Surg Am 93:e87(1)–e87(7)
Chenot R, Scheidt-Nave C, Gabler S, Kochen M, Himmel W (2007) German primary care doctor’s awareness of osteoporosis and knowledge of national guidelines. Exp Clin Endocrinol Diabetes 115:584–589
Rosenwasser M, Cuellar D (2016) Medical management of osteoporosis and the surgeons’ role. Injury 47(Supplement 1):S62–S64
Kanis J, Harvey N, Johansson H, Odén A, Leslie W, McCloskey E (2015) FRAX and fracture prediction without bone mineral density. Climacteric 18:2–9
Hochberg M (2000) Preventing fractures in postmenopausal women with osteoporosis. Drugs Aging 17:317–330
Papaioannou A, Morin S, Cheung A, Aktinson S, Brown J, Feldman S, Hanley D, Hodsman A, Jamal S, Kaiser S, Kvern B, Siminoski K, Leslie W (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182(17):1864–1873
Leslie W, Schousboe J (2011) A review of osteoporosis diagnosis and treatment options in new and recently updated guidelines on case finding around the world. Curr Osteoporos Rep 9:129–140
Kanis J, Compston J, Cooper C, Harvey N, Johansson H, Odén A, McCloskey E (2016) SIGN guidelines for Scotland: BMD versus FRAX versus QFracture. Calcif Tissue Int 98:417–425
Schuit S, van der Klift M, Weel A, de Laet C, Burger H, Seeman E, Hofman A, Uitterlinden A, van Leeuwen J, Pols H (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone 34:195–202
Kanis J, McCloskey E, Branco J, Brandi M, Dennison E, Devogelaer J, Ferrari S, Kaufman J, Papapoulos S, Reginster J, Rizzoli R (2014) Goal-directed treatment of osteoporosis in Europe. Osteoporos Int 25:2533–2543
Grey A, Bolland M (2013) The effect of treatments for osteoporosis on mortality. Osteoporos Int 24:1–6
Bolland M, Grey A, Gamble G, Reid I (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. The Journal of Clinical Endocrinology & Metabolism 95:1174–1181
Hudec S, Camacho P (2012) Secondary causes of osteoporosis. Endocr Pract 19:120–128
Waring A, Harrison S, Fink H, Samuels M, Cawthon P, Zmuda J, Orwoll E, Bauer D (2013) A prospective study of thyroid function, bone loss, and fractures in older men: the MrOS study. J Bone Miner Res 28:472–479
Kushnir-Sukhov N, Brittain E, Reynolds J, Akin C, Metcalfe D (2006) Elevated tryptase levels are associated with greater bone density in a cohort of patients with mastocytosis. Int Arch Allergy Immunol 139:265–270
Bours S, van Geel T, Geusens P, Janssen M, Janzing H, Hoffland GA, Willems P, van den Bergh J (2011) Contributors to secondary osteoporosis and metabolic bone disease in patients presenting with clinical fracture. The Journal of Clinical Endocrinology & Metabolism 96:1360–1367
Kanis, JA and on behalf of the WHO Scientific Group (2007) Assessment of osteoporosis at the primary health care level. www.shef.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf
Vogel T, Kampmann P, Bürklein D, Böhm H, Ockert B, Kirchhoff C, Kanz K, Pfeifer K, Mutschler W (2008) Reality of treatment of osteoporotic fractures in German trauma department. Unfallchirurg 111:869–877
Suhm N, Lamy O, Lippuner K (2008) Management of fragility fractures in Switzerland: results of a nationwide survey. Swiss Med Wkly 138:674–683
McLellan A, Wolowacz S, Zimovetz E, Beard S, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22:2083–2098
Little E, Eccles M (2010) A systematic review of the effectivness of interventions to improve post-fracture investigation and managment of patients at risk of osteoporosis. Implement Sci 5:80–97
Acknowledgements
The authors would like to thank all hospital collaborators and Ms. J. Buchanan for editorial assistance.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study was approved by the Cantonal Ethics Board and supported financially by the Research Fund of the Hospital.
Conflicts of interest
None.
Rights and permissions
About this article
Cite this article
Hemmeler, C., Morell, S., Amsler, F. et al. Screening for osteoporosis following non-vertebral fractures in patients aged 50 and older independently of gender or level of trauma energy—a Swiss trauma center approach. Arch Osteoporos 12, 38 (2017). https://doi.org/10.1007/s11657-017-0334-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-017-0334-3