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Bone and Fall-Related Fracture Risks in Women and Men with a Recent Clinical Fracture
Svenhjalmar van Helden, MD1; Antonia C.M. van Geel, MSc2; Piet P. Geusens, MD, PhD3; Alfons Kessels, MD, MSc3; Arie C. Nieuwenhuijzen Kruseman, MD, PhD3; Peter R.G. Brink, MD, PhD1
1 Department of General Surgery and Trauma Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail address for S. van Helden: svhl@surgery.azm.nl
2 Department of General Practice, Maastricht University, Universiteitssingel 40, 6200 MD Maastricht, The Netherlands
3 Department of Internal Medicine (P.P.G. and A.C.N.K.) and Clinical Epidemiology and Medical Technology Assessment (KEMTA) (A.K.), University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Merck Sharp & Dohme. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Merck Sharp & Dohme). Also, a commercial entity (Procter & Gamble) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
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Investigation performed at the University Hospital Maastricht, Maastricht, The Netherlands

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Feb 01;90(2):241-248. doi: 10.2106/JBJS.G.00150
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Background: Worldwide fracture rates are increasing as a result of the aging population, and prevention, both primary and secondary, is an important public health goal. Therefore, we systematically analyzed risk factors in subjects with a recent clinical fracture.

Methods: All men and women over fifty years of age who had been treated in the emergency department of, or hospitalized at, our institution because of a recent fracture during a one-year period were offered the opportunity to undergo an evidence-based bone and fall-related risk-factor assessment and bone densitometry. The women included in this study were also compared with a group of postmenopausal women without a fracture history who had been included in another cohort study.

Results: Of the 940 consecutive patients, 797 (85%) were eligible for this study and 568 (60%) agreed to participate. The prevalence of fall-related risk factors (75% [95% confidence interval = 71% to 78%]; n = 425) and the prevalence of bone-related risk factors (53% [95% confidence interval = 49% to 57%]; n = 299) at the time of fracture were higher than the prevalence of osteoporosis (35% [95% confidence interval = 31% to 39%]; n = 201) as defined by a dual x-ray absorptiometry T score of =-2.5 in the spine and/or hip. The fall and bone-related risk factors were present irrespective of the fracture location, patient age, or gender. An overlap between bone and fall-related risk factors was found in 50% of the patients. After adjusting for age, weight, and height, we found that women with a fracture more frequently had a diagnosis of osteoporosis (odds ratio = 2.9; 95% confidence interval = 2.0 to 4.1) and had a more extensive history of falls (odds ratio = 4.0; 95% confidence interval = 2.7 to 5.9) than did the postmenopausal women without a fracture history.

Conclusions: Men and women over fifty years of age who had recently sustained a clinical fracture had, at the time of that fracture, bone and fall-related risk factors that were greater than the risk predicted by the presence of osteoporosis. Risk factors were overlapping, heterogeneous, and found in multiple combinations. This was the case regardless of the patient's age, fracture location, or gender. These findings suggest that an integrated bone and fall-related risk-factor assessment is a preferable means for identifying elderly subjects at risk for fracture. Integrated bone and fall-related risk assessment and treatment studies are needed to document this proposal.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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