Résumé
Les fractures du col fémoral, des vertèbres et du poignet sont traditionnellement rapportées à l’ostéoporose, mais la plupart des fractures qui surviennent chez les femmes de plus de 60 ans sont liées à une densité minérale osseuse (DMO) abaissée et peuvent donc être considérées comme des fractures ostéoporotiques. En l’absence de mesures de prévention efficaces, des estimations américaines indiquent que 40 femmes de 50 ans sur 100 souffriront d’au moins d’une fracture ostéoporotique majeure (col fémoral, vertèbre, poignet) avant la fin de leur vie. En France, le nombre annuel de fractures du col du fémur, estimé à environ 50 000 en 1990, devrait tripler d’ici 2050. Les personnes qui ont souffert d’une première fracture ont deux fois plus de risque de souffrir d’une nouvelle fracture. Du fait de leur fréquence, de leur impact sur la santé et de leur coût pour la société, les fractures ostéoporotiques sont désormais reconnues comme un enjeu important de santé publique. Le déterminisme des fractures est multifactoriel, et des outils cliniques combinant mesure de la DMO et facteurs de risque cliniques ont été développés pour identifier les personnes à risque susceptibles de bénéficier d’un traitement de l’ostéoporose préventif des fractures. La majorité des fractures sont la conséquence d’une chute et les facteurs connus de chute et de traumatisme augmentent le risque de fracture, notamment du col fémoral, indépendamment du niveau de DMO. Les recherches sur la prévention des chutes chez les personnes âgées pourraient ouvrir de nouvelles pistes pour diminuer de façon significative le nombre de fractures à l’échelle de la population.
Abstract
Fractures of the hip, vertebral body, and distal forearm have long been regarded as the typical osteoporotic fractures. But most fractures occurring in women aged 60 and over have an increased incidence in women with low bone mineral density and can therefore be considered as a manifestation of osteoporosis. It has been estimated that the remaining lifetime risk of a major osteoporotic fracture (hip, vertebrae, forearm) is 40% for American white women. In France, the annual number of hip fracture, estimated around 50,000 in 1990, is expected to triple by 2050. The risk of fracture is two times higher in subjects who already suffered a fracture. Given their frequency, health impact and societal cost, osteoporotic fractures are largely recognized as a major public health problem. The etiology of fractures is multifactorial, and clinical tools combining bone mineral density and clinical factors have been developed to better identify subjects at high-risk who may benefit from an osteoporosis treatment preventive of fractures. The majority of fractures are a consequence of a fall, and known risk factors for falls and trauma have been shown to increase the risk of fracture, in particular of the femoral neck, independently of bone mineral density. Research on falls prevention in the elderly may open new perspectives to significantly reduce the number of fractures in the population.
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Dargent-Molina, P. Aspects épidémiologiques des fractures ostéoporotiques. cah. année gerontol. 1, 164–171 (2009). https://doi.org/10.1007/s12612-009-0026-8
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DOI: https://doi.org/10.1007/s12612-009-0026-8