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High-Trauma Fractures in Older Men and Women Linked to Osteoporosis

November 29, 2007

Researchers at the California Pacific Medical Center (CPMC) Research Institute are challenging a widely held belief that fractures resulting from major trauma, such as automobile accidents, are not related to osteoporosis, the common disease that makes bones weak and prone to fracture. Their study, published in the November 28 issue of the Journal of the American Medical Association, was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the National Institute on Aging (NIA). NIAMS and NIA are components of the National Institutes of Health.

People with osteoporosis, a condition of low bone mineral density, experience fractures from a level of force that would not break a healthy bone. Although clinicians often recognize fractures resulting from minimal trauma as osteoporotic, those related to more substantial injury are rarely given the same consideration. "We know that too many clinicians pass on any follow-up of many fracture patients because, in their minds, the patient 'earned' their fracture," says Joan A. McGowan, Ph.D., director of the Division of Musculoskeletal Diseases at NIAMS. "These missed opportunities can have a devastating impact on these men and women, who, without proper management, are at increased risk for subsequent fracture."

CPMC's Steven R. Cummings, M.D., and his colleagues analyzed data from two large prospective cohort studies: the Study of Osteoporotic Fractures (SOF) in women and the Osteoporotic Fractures in Men Study (Mr. OS). The SOF followed 8,022 women for nine years and Mr. OS tracked 5,995 men for five years. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DXA). Study participants were contacted every four months to determine whether they experienced a fracture in the previous four-month period.

When a fracture was reported, clinical staff interviewed the participant to learn how it occurred. Without knowledge of the participant's BMD, staff classified each fracture as high-trauma or low-trauma. High-trauma fractures were defined as those caused by motor vehicle crashes and falls from greater than standing height, and low-trauma fractures were defined as those resulting from falls from standing height and less severe trauma.

Cummings and his team discovered that the relationship between BMD and fracture risk was similar for high-trauma and low-trauma fractures. They also found that women who experienced a high-trauma fracture were at increased risk for future fractures. (A similar analysis was not conducted in men because of the shorter follow-up time.) "It is becoming increasingly clear that any fracture experienced by an older individual is worthy of an osteoporosis evaluation," says Sheryl S. Sherman, Ph.D., Geriatrics and Clinical Gerontology Branch, NIA.

"We believe that this study changes the definition of osteoporotic fracture and expands the number of fractures that should be considered as such," Cummings says. "Moreover, it is critical that fractures that occur as a result of high trauma be included as outcomes in future studies, so that we may fully understand the impact of these fractures and develop strategies to prevent them."

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a part of the Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at http://www.niams.nih.gov. Information on osteoporosis and other bone disorders is available from the NIH Osteoporosis and Related Bone Diseases~National Resource Center; phone toll-free 800-624-BONE (2663), or visit www.niams.nih.gov/bone .

NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer's disease and age-related cognitive change. For information on dementia and aging, please visit NIA's Alzheimer's Disease Education and Referral Center at www.nia.nih.gov/alzheimers, or call 1-800-438-4380. For more general information on research and aging, go to www.nia.nih.gov. Please visit the Web sites to sign up for e-mail notification of new information and publications about aging and about age-related cognitive change.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

The National Institutes of Health (NIH)