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High-trauma fractures and low bone mineral density in older women and men.
JAMA 2007; 298(20):2381-8JAMA

Abstract

CONTEXT

It is widely believed that fractures resulting from high trauma are not osteoporotic; however, this assumption has not been studied prospectively.

OBJECTIVE

To examine the association between bone mineral density (BMD) and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men.

DESIGN, SETTING, AND PARTICIPANTS

Two prospective US cohort studies in community-dwelling adults 65 years or older from geographically diverse sites. The Study of Osteoporotic Fractures followed up 8022 women for 9.1 years (1988-2006). The Osteoporotic Fractures in Men Study followed up 5995 men for 5.1 years (2000-2007).

MAIN OUTCOME MEASURES

Hip and spine BMD were assessed by dual-energy x-ray absorptiometry. Incident nonspine fractures were confirmed by radiographic report. Fractures were classified, without knowledge of BMD, as high trauma (due to motor vehicle crashes and falls from greater than standing height) or as low trauma (due to falls from standing height and less severe trauma).

RESULTS

Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3211 women and 346 men sustained an initial low-trauma fracture. For women, each 1-SD reduction in total hip BMD was similarly associated with an increased risk of high-trauma fracture (multivariate relative hazard [RH], 1.45; 95% confidence interval [CI], 1.23-1.72) and low-trauma fracture (RH, 1.49; 95% CI, 1.42-1.57). Results were consistent in men (high-trauma fracture RH, 1.54; 95% CI, 1.20-1.96; low-trauma fracture RH, 1.69; 95% CI, 1.49-1.91). Risk of subsequent fracture was 34% (95% CI, 7%-67%) greater among women with an initial high-trauma fracture and 31% (95% CI, 20%-43%) greater among women with an initial low-trauma fracture, compared with women having no high- or low-trauma fracture, respectively. Risk of subsequent fracture was not modeled for men.

CONCLUSIONS

Similar to low-trauma nonspine fractures, high-trauma nonspine fractures are associated with low BMD and increased risk of subsequent fracture in older adults. High-trauma nonspine fractures should be included as outcomes in osteoporosis trials and observational studies.

Authors+Show Affiliations

San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California 94107, USA. dmackey@sfcc-cpmc.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18042915

Citation

Mackey, Dawn C., et al. "High-trauma Fractures and Low Bone Mineral Density in Older Women and Men." JAMA, vol. 298, no. 20, 2007, pp. 2381-8.
Mackey DC, Lui LY, Cawthon PM, et al. High-trauma fractures and low bone mineral density in older women and men. JAMA. 2007;298(20):2381-8.
Mackey, D. C., Lui, L. Y., Cawthon, P. M., Bauer, D. C., Nevitt, M. C., Cauley, J. A., ... Cummings, S. R. (2007). High-trauma fractures and low bone mineral density in older women and men. JAMA, 298(20), pp. 2381-8.
Mackey DC, et al. High-trauma Fractures and Low Bone Mineral Density in Older Women and Men. JAMA. 2007 Nov 28;298(20):2381-8. PubMed PMID: 18042915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-trauma fractures and low bone mineral density in older women and men. AU - Mackey,Dawn C, AU - Lui,Li-Yung, AU - Cawthon,Peggy M, AU - Bauer,Douglas C, AU - Nevitt,Michael C, AU - Cauley,Jane A, AU - Hillier,Teresa A, AU - Lewis,Cora E, AU - Barrett-Connor,Elizabeth, AU - Cummings,Steven R, AU - ,, PY - 2007/11/29/pubmed PY - 2007/12/6/medline PY - 2007/11/29/entrez SP - 2381 EP - 8 JF - JAMA JO - JAMA VL - 298 IS - 20 N2 - CONTEXT: It is widely believed that fractures resulting from high trauma are not osteoporotic; however, this assumption has not been studied prospectively. OBJECTIVE: To examine the association between bone mineral density (BMD) and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men. DESIGN, SETTING, AND PARTICIPANTS: Two prospective US cohort studies in community-dwelling adults 65 years or older from geographically diverse sites. The Study of Osteoporotic Fractures followed up 8022 women for 9.1 years (1988-2006). The Osteoporotic Fractures in Men Study followed up 5995 men for 5.1 years (2000-2007). MAIN OUTCOME MEASURES: Hip and spine BMD were assessed by dual-energy x-ray absorptiometry. Incident nonspine fractures were confirmed by radiographic report. Fractures were classified, without knowledge of BMD, as high trauma (due to motor vehicle crashes and falls from greater than standing height) or as low trauma (due to falls from standing height and less severe trauma). RESULTS: Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3211 women and 346 men sustained an initial low-trauma fracture. For women, each 1-SD reduction in total hip BMD was similarly associated with an increased risk of high-trauma fracture (multivariate relative hazard [RH], 1.45; 95% confidence interval [CI], 1.23-1.72) and low-trauma fracture (RH, 1.49; 95% CI, 1.42-1.57). Results were consistent in men (high-trauma fracture RH, 1.54; 95% CI, 1.20-1.96; low-trauma fracture RH, 1.69; 95% CI, 1.49-1.91). Risk of subsequent fracture was 34% (95% CI, 7%-67%) greater among women with an initial high-trauma fracture and 31% (95% CI, 20%-43%) greater among women with an initial low-trauma fracture, compared with women having no high- or low-trauma fracture, respectively. Risk of subsequent fracture was not modeled for men. CONCLUSIONS: Similar to low-trauma nonspine fractures, high-trauma nonspine fractures are associated with low BMD and increased risk of subsequent fracture in older adults. High-trauma nonspine fractures should be included as outcomes in osteoporosis trials and observational studies. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/18042915/High_trauma_fractures_and_low_bone_mineral_density_in_older_women_and_men_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.298.20.2381 DB - PRIME DP - Unbound Medicine ER -