Skip to main content

Advertisement

Log in

Osteoporosis onset differences between rural and metropolitan populations: correlation to fracture type, severity, and treatment efficacy

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Osteoporosis is the prevalent cause of fractures in an ever-aging population, with an established correlation between daily activities and way of life. We aimed to delineate differences in onset of osteoporosis, T-score progression, quality of life, and correlation to prevalence, types, and severity of fractures in age-comparable populations of rural and metropolitan habitats in this multicenter, retrospective double-blind study. We evaluated data derived from the medical files of two comparable groups of osteoporotic patients: group A (n = 530, rural area) and group B (n = 171, metropolitan area). Both groups received comparable treatment for osteoporosis. Comparison was performed on the basis of osteoporosis onset, T-score in a maximum of 8 years follow-up, fracture types [American Academy of Orthopaedic Surgeons (AO) categorization], and type of treatment followed. Quality of life was assessed by use of specialized questionnaires. From the minimum 4-year follow-up of all patients included in the research, there was a statistically significant difference in favor of the rural population in all research parameters. Rural populations presented with osteoporosis at a later age than their metropolitan counterparts, exhibiting favorable T-scores with comparable treatments and simpler fractures (AO categorization). Metropolitan habitats and life therein have a deleterious effect on osteoporosis onset and response to treatment. Rural populations are diagnosed with osteoporosis on a later age, with better compliance and improved treatment outcome. Fracture categorization shows increased severity in the metropolitan populace and a suggested correlation between a poor-quality way of life and decreased activity levels.

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.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Islam S, Liu Q, Chines A, Helzner E (2009) Trend in incidence of osteoporosis-related fractures among 40- to 69-year-old women: analysis of a large insurance claims database, 2000–2005. Menopause 16:77–83

    Article  PubMed  Google Scholar 

  2. Dempster D, Benzaia D (2003) Rapid fracture protection in the treatment of osteoporosis. Clin Rev

  3. NAMS (2010) Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause 17:25–54

    Article  Google Scholar 

  4. Boonen S, Kay R, Cooper C, Haentjens P, Vanderschueren D, Callewaert F, Milisen K, Ferrari S (2009) Osteoporosis management: a perspective based on bisphosphonate data from randomised clinical trials and observational databases. Int J Clin Pract 63:1792–1804

    Article  PubMed  CAS  Google Scholar 

  5. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  PubMed  CAS  Google Scholar 

  6. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, 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

    Article  PubMed  Google Scholar 

  7. Manolagas SC (2000) Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev 21:115–137

    Article  PubMed  CAS  Google Scholar 

  8. Garnero P, Sornay-Rendu E, Chapuy M-C, Delmas PD (1996) Increased bone turnover in late menopausal women is a major determinant of osteoporosis. J Bone Miner Res 11:337–349

    Article  PubMed  CAS  Google Scholar 

  9. Riggs BL, Khosla S, Melton LJ 3rd (2002) Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev 23:232–279

    Article  Google Scholar 

  10. Bagger YZ, Tanko LB, Alexandersen P, Hansen HB, Qin G, Christiansen C (2006) The long-term predictive value of bone mineral density measurements for fracture risk is independent of the site of measurement and the age at diagnosis: results from the Prospective Epidemiological Risk Factors study. Osteoporos Int 17:471–477

    Article  PubMed  Google Scholar 

  11. Stone KL, Seeley DG, Lui L-Y et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954

    Article  PubMed  Google Scholar 

  12. Leslie WD, MacWilliam L, Lix L, Caetano P, Finlayson GS (2005) A population-based study of osteoporosis testing and treatment following introduction of a new bone densitometry service. Osteoporos Int 16:773–782

    Article  PubMed  Google Scholar 

  13. Fitt NS, Mitchell SN, Cranney A, Gulenchyn K, Huang M, Tugwell P (2001) Influence of bone densitometry results on the treatment of osteoporosis. CMAJ 6:777–781

    Google Scholar 

  14. Cadarette SM, Gignac MA, Jaglal SB, Beaton DE, Hawker GA (2007) Access to osteoporosis treatment is critically linked to access to dual-energy x-ray absorptiometry testing. Med Care 45:896–901

    Article  PubMed  Google Scholar 

  15. Wasnich RD, Bagger YZ, Hosking DJ et al (2004) Changes in bone density and turnover after alendronate or estrogen withdrawal. Menopause 11:622–630

    Article  PubMed  Google Scholar 

  16. Gallagher J, Rapuri PB, Haynatzki G, Detter JR (2002) Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers. J Clin Endocrinol Metab 87:4914–4923

    Article  PubMed  CAS  Google Scholar 

  17. Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults. J Bone Joint Surg Br 80:243–248

    Article  PubMed  CAS  Google Scholar 

  18. Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674

    Article  PubMed  CAS  Google Scholar 

  19. Maravic M, Le Bihan C, Landais P, Fardellone P (2005) Incidence and cost of osteoporotic fractures in France during 2001. A methodological approach by the national hospital database. Osteoporos Int 16:1475–1480

    Article  PubMed  Google Scholar 

  20. Sanders KM, Seeman E, Ugoni AM et al (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int 10:240–247

    Article  PubMed  CAS  Google Scholar 

  21. Laster AJ, Lewiecki EM (2007) Vertebral fracture assessment by dual-energy x-ray absorptiometry: insurance coverage issues in the United States. J Clin Densitom 10:227–238

    Article  PubMed  Google Scholar 

  22. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795

    Google Scholar 

  23. Ensrud KE, Lipschutz RC, Cauley JA et al (1997) Body size and hip fracture risk in older women: a prospective study. Am J Med 103:274–280

    Article  PubMed  CAS  Google Scholar 

  24. Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone (NY) 32:78–85

    Article  CAS  Google Scholar 

  25. Gallagher JC (2007) Effect of early menopause on bone mineral density and fractures. Menopause 14:567–571

    Article  PubMed  Google Scholar 

  26. Canalis E, Mazziotti G, Giustina A, Bilezikian JP (2007) Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 18:1319–1328

    Article  PubMed  CAS  Google Scholar 

  27. Looker AC, Harris TB, Madans JH, Sempos CT (1993) Dietary calcium and hip fracture risk: the NHANES I Epidemiologic Follow-Up Study. Osteoporos Int 3:177–184

    Article  PubMed  CAS  Google Scholar 

  28. Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of major effect. BMJ 315:841–846

    Article  PubMed  CAS  Google Scholar 

  29. Hernandez-Avila M, Colditz GA, Stampfer MJ et al (1991) Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women. Am J Clin Nutr 54:157–163

    PubMed  CAS  Google Scholar 

  30. Centers for Disease Control and Prevention (CDC) (2006) Tobacco use among adults: United States, 2005. MMWR Morb Mortal Wkly Rep 55:1145–1148

    Google Scholar 

  31. Lane NE (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 194 (suppl):S3–S11

    Article  Google Scholar 

  32. Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD (2007) Low bone mineral density and fracture burden in postmenopausal women. CMAJ 177:575–580

    Article  PubMed  Google Scholar 

  33. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227 (abstract)

    Article  PubMed  CAS  Google Scholar 

  34. Oleksik A, Lips P, Dawson A et al (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392 (abstract)

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  36. Schott AM, Cormier C, Hans D et al (1998) How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int 8:247–254 (abstract)

    Article  PubMed  CAS  Google Scholar 

  37. Melton LJ 3rd, Kan SH, Wahner HW, Riggs BL (1988) Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age. J Clin Epidemiol 41:985–994

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

There is no conflict of interest for any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Pagonis.

About this article

Cite this article

Pagonis, T., Givissis, P., Pagonis, A. et al. Osteoporosis onset differences between rural and metropolitan populations: correlation to fracture type, severity, and treatment efficacy. J Bone Miner Metab 30, 85–92 (2012). https://doi.org/10.1007/s00774-011-0286-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-011-0286-4

Keywords

Navigation