Two-thirds of all fractures are not attributable to osteoporosis and advancing age: implication for fracture prevention.

Publication Type:
Journal Article
The Journal of clinical endocrinology and metabolism, 2019, 104, (8), pp. 3514-3520
Issue Date:
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CONTEXT:Although bone mineral density (BMD) is strongly associated with fracture and post-fracture mortality, the burden of fractures attributable to low BMD has not been investigated. OBJECTIVES:We sought to estimate the population attributable fraction (PAF) of fractures and fracture-related mortality that can be attributed to low BMD. DESIGN AND SETTING:This study is a part of an ongoing population-based prospective cohort study, Dubbo Osteoporosis Epidemiology study. In total, 3700 participants aged from 50 years and older had participated in the study. Low-trauma fracture was ascertained by X-ray reports, and mortality was ascertain from the Birth, Death and Marriage Registry. RESULTS:Overall, 21% of women and 11% of men had osteoporotic BMD. In univariable analysis, 21% and 16% of total fractures in women and men, respectively, were attributable to osteoporosis. Osteoporosis combined with advancing age (>70 yrs) accounted for 34% and 35% of fractures in women and men, respectively. However, these two factors accounted for ∼60% of hip fractures. About 99% and 66% of postfracture mortality in women and men, respectively, were attributable to advancing age, osteoporosis and fracture; however, most of the attributable proportion was accounted for advancing age. CONCLUSIONS:A substantial health care burden of fracture is on individuals aged <70 years and/or non-osteoporosis, suggesting that treatment of individuals with osteoporosis is unlikely to reduce a large number of fractures in the general population.
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