Abstract
After the occurrence of the first fracture, osteoporosis is no longer a “silent” disease, and the patient’s risk for future fracture is increased several fold. We assessed the location of first osteoporotic fractures among women with osteoporosis. The Multiple Outcomes of Raloxifene Evaluation (MORE) trial was a fracture outcomes study of postmenopausal women with osteoporosis. All subjects received supplements containing 500 mg elemental calcium and 400–600 IU vitamin D. We assessed the location of first fractures among women with osteoporosis and no previous fractures at baseline from the placebo group of this trial after 3 years of follow-up. Prespecified fracture sites included vertebral fractures and nonvertebral fractures as defined in the MORE study protocol. Among 875 women (mean age, 64.5 ± 7.4 years) with no prevalent vertebral or nonvertebral fractures, 9% experienced their first fracture event during the trial. Fractures of radius and spine each occurred in 3% of patients. Fractures at other individual sites included ankle (0.6%), metatarsal (0.6%), humerus (0.5%), rib (0.5%), patella (0.3%), leg (0.2%), hip (0.2%), and clavicle (0.1%). These data suggest that for postmenopausal women with osteoporosis but no previous fractures, skeletal care should include a focus on preventing spine and radius fractures.
References
Epstein S (2000) Postmenopausal osteoporosis: fracture consequences and treatment efficacy vary by skeletal site. Aging 12:330–341
Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221
Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770
Silverman SL, Delmas PD, Kulkarni PM, Stock JL, Wong M, Plouffe L Jr (2004) Comparison of fracture, cardiovascular event, and breast cancer rates at 3 years in postmenopausal women with osteoporosis. J Am Geriatr Soc 52:1543–1548
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
Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645
Kanis JA, Johnell O, Black DM, Downs RW Jr, Sarkar S, Fuerst T, Secrest RJ, Pavo I (2003) Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a reanalysis of the Multiple Outcomes of Raloxifene Evaluation trial. Bone 33:293–300
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795
Watts NB, Lewiecki EM, Miller PD, Baim S (2008) National Osteoporosis Foundation 2008 Clinician’s Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom 11:473–477
Vogt MT, Cauley JA, Tomaino MM, Stone K, Williams JR, Herndon JH (2002) Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc 50:97–103
Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ, for the Fracture Intervention Trial Research Group (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures. JAMA 280:2077–2082
US Department of Health and Human Services (2004) Bone health and osteoporosis: a report of the surgeon general. Office of the Surgeon General, 30 June 2004. Public Health Service, Rockville, MD
Acknowledgments
The authors thank Dr. Xiaohai Wan for statistical analysis.
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Sontag, A., Krege, J.H. First fractures among postmenopausal women with osteoporosis. J Bone Miner Metab 28, 485–488 (2010). https://doi.org/10.1007/s00774-009-0144-9
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DOI: https://doi.org/10.1007/s00774-009-0144-9