Older Adults Face Increased Risk of Death Following
Osteoporotic Fracture
These data suggest fracture is a signal event that
heralds an increased mortality risk
Feb.
3, 2009 - Women and men age 60 years or older who have a low-trauma
osteoporotic fracture have an increased risk of death for the following
5 to 10 years, compared to the general population, and those who
experience another fracture increase their risk of death further for an
additional 5 years, according to a study in the February 4 issue of the
Journal of the American Medical Association (JAMA). Those age 75 and
older face increased risk of death from even a minor fracture.
Osteoporotic fractures represent a growing public
health problem in both developed and developing countries, with a
projected increasing incidence as the population ages. Bones become
porous from osteoporosis as they lose protein, calcium and other mineral
content. In this more fragile state, bones break easily.
There are limited data on the long-term risk of
death following these osteoporotic fractures or a subsequent fracture,
according to background information in the article.
Dana Bliuc, M.Med., of the Garvan Institute of
Medical Research, St. Vincent's Hospital, Sydney, Australia, and
colleagues examined the long-term risk of death (up to 18 years)
following all types of osteoporotic fractures in women and men in
different age groups and the association of subsequent fracture with
mortality risk.
The study included women and men age 60 years and
older from Dubbo, Australia (in 1989, this consisted of 2,245 women and
1,760 men) who sustained a fracture between April 1989 and May 2007.
In women, there were 952 low-trauma fractures
followed by 461 deaths, and in men, 343 fractures were followed by 197
deaths.
In comparison to the general population, increased
mortality risk was observed across all age groups following hip,
vertebral, and major fractures for 5 years post-fracture, except for
minor fractures, where an increased risk of death was only apparent in
those age 75 years or older.
Osteoporotic Fracture
The word osteoporosis
literally means "porous bones." It occurs when bones lose an
excessive amount of their protein and mineral content,
particularly calcium. Over time, bone mass, and therefore bone
strength, is decreased. As a result, bones become fragile and
break easily. Even a sneeze or a sudden movement may be enough
to break a bone in someone with severe osteoporosis.
Bones become porous from
osteoporosis as they lose protein, calcium and other mineral
content. In this more fragile state, bones break more easily.
After five years, the mortality risk decreased,
with hip fractureassociated mortality remaining elevated for up to 10
years. After 10 years, mortality rates were not different from that of
an appropriately age-matched population.
"Nonhip, nonvertebral fractures, generally not
considered in these types of studies, not only constituted almost 50
percent of the fractures studied, but also were associated with 29
percent of the premature mortality.
Mortality risk decreased with time; however, the
occurrence of a subsequent fracture was associated with a 3- to 4-fold
increased mortality risk for a further 5 years," the authors write.
"Given these findings, more attention should be
given to nonhip, nonvertebral fractures..."
Predictors of death after any fragility fracture
for both men and women included age, quadriceps weakness and subsequent
fracture but not co-existing illnesses. Low bone mineral density and
having smoked were also predictors for women and less physical activity
for men.
"These data suggest fracture is a signal event that
heralds an increased mortality risk: whether it is related to an
underlying increased risk for both fracture and mortality, which may be
the case for women, or whether it is related to some aspect of the
fracture event itself, as appears to be the case for men, needs further
exploration. Overall, this study highlights the premature mortality
associated with all types of fractures, particularly that which occurs
after subsequent fracture across the whole age spectrum of older men and
women," the researchers conclude.
About Osteoporosis
Osteoporosis
makes your bones weak and more likely to break. Anyone can develop
osteoporosis, but it is common in older women. As many as half of all
women and a quarter of men older than 50 will break a bone due to
osteoporosis.
Risk factors include
● Getting older
● Being small and thin
● Having a family history of osteoporosis
● Taking certain medicines
● Being a white or Asian woman
● Having osteopenia, which is low bone mass
Osteoporosis is a silent disease. You might not
know you have it until you break a bone. A bone mineral density test is
the best way to check your bone health. To keep bones strong, eat a diet
rich in calcium and vitamin D, exercise and do not smoke. If needed,
medicines can also help.
Fractures
Many people are unaware of the link between a
broken bone and osteoporosis. Osteoporosis, or "porous bone," is a
disease characterized by low bone mass. It makes bones fragile and more
prone to fractures, especially of the hip, spine, and wrist.
Osteoporosis is called a "silent disease" because bone loss occurs
without symptoms. People typically do not know that they have
osteoporosis until their bones become so weak that a sudden strain,
twist, or fall results in a fracture.
Osteoporosis is a major public health threat for an
estimated 44 million Americans. In the United States today,
approximately 10 million people already have the disease and almost 34
million more are believed to have low bone mass, which leaves them at
increased risk for osteoporosis. Of the 10 million Americans estimated
to have osteoporosis, eight million are women and two million are men.
One in two women and one in four men will have an
osteoporosis-related fracture in their lifetime. At least 90 percent of
all hip and spine fractures among older white women can be attributed to
underlying bone fragility. Moreover, women near or past menopause who
have sustained a fracture in the past are twice as likely to experience
another fracture. Yet, unfortunately, only 5 percent of patients with
osteoporotic fractures are referred for an osteoporosis evaluation and
medical treatment. (Click
to more about Osteoporosis Fractures)
Facts and Figures
●
Osteoporosis is a major public health threat for 44 million Americans,
68 percent of whom are women.
● In
the U.S. today, 10 million individuals already have osteoporosis and 34
million more have low bone mass, placing them at increased risk for this
disease.
● One
out of every two women and one in four men over 50 will have an
osteoporosis-related fracture in their lifetime.
●
More than 2 million American men suffer from osteoporosis, and millions
more are at risk. Each year, 80,000 men have a hip fracture and
one-third of these men die within a year.
●
Osteoporosis can strike at any age.
●
Osteoporosis is responsible for more than 1.5 million fractures
annually, including 300,000 hip fractures, approximately 700,000
vertebral fractures, 250,000 wrist fractures, and more than 300,000
fractures at other sites.
●
Based on figures from hospitals and nursing homes, the estimated
national direct expenditures for osteoporosis and related fractures
total $14 billion each year.
Risk Factors
Certain risk factors are linked to the development
of osteoporosis and contribute to an individual's likelihood of
developing the disease. Many people with osteoporosis have several risk
factors, but others who develop the disease have no known risk factors.
There are some you cannot change and others you can.
Risk factors you cannot change:
●
Gender - Your chances of developing osteoporosis are greater if you are
a woman. Women have less bone tissue and lose bone faster than men
because of the changes that happen with menopause.
● Age
- The older you are, the greater your risk of osteoporosis. Your bones
become thinner and weaker as you age.
●
Body size - Small, thin-boned women are at greater risk.
●
Ethnicity - Caucasian and Asian women are at highest risk. African
American and Hispanic women have a lower but significant risk.
●
Family history - Fracture risk may be due, in part, to heredity. People
whose parents have a history of fractures also seem to have reduced bone
mass and may be at risk for fractures.
Risk factors you can change:
● Sex
hormones - Abnormal absence of menstrual periods (amenorrhea), low
estrogen level (menopause), and low testosterone level in men can bring
on osteoporosis.
●
Anorexia nervosa - Characterized by an irrational fear of weight gain,
this eating disorder increases your risk for osteoporosis.
●
Calcium and vitamin D intake - A lifetime diet low in calcium and
vitamin D makes you more prone to bone loss.
●
Medication use - Long-term use of glucocorticoids and some
anticonvulsants can lead to loss of bone density and fractures.
●
Lifestyle - An inactive lifestyle or extended bed rest tends to weaken
bones.
●
Cigarette smoking - Cigarettes are bad for bones as well as the heart
and lungs.
●
Alcohol intake - Excessive consumption increases the risk of bone loss
and fractures.
Feb.
3, 2009 - Women and men age 60 years or older who have a low-trauma
osteoporotic fracture have an increased risk of death for the following
5 to 10 years, compared to the general population, and those who
experience another fracture increase their risk of death further for an
additional 5 years, according to a study in the February 4 issue of the
Journal of the American Medical Association (JAMA). Those age 75 and
older face increased risk of death from even a minor fracture.
Osteoporosis
makes your bones weak and more likely to break. Anyone can develop
osteoporosis, but it is common in older women. As many as half of all
women and a quarter of men older than 50 will break a bone due to
osteoporosis.