Association Between Self-Reported Prior Wrist Fractures and Risk of Subsequent Hip and Radiographic Vertebral Fractures in Older Women: A Prospective Study

Abstract

ABSTRACT:In this large prospective cohort study of elderly women, the relationships between prior wrist fracture and incident hip and radiographic vertebral fractures were significantly attenuated when adjusted for BMD. This study suggests that BMD thresholds for drug therapy to prevent osteoporotic fracture should be only modestly adjusted in those with prior wrist fracture compared with those without prior wrist fracture. Validation of such an approach would require intervention trials in patients with prior wrist fracture.Introduction: Prior wrist fracture has been identified as a risk factor for incident hip and vertebral fractures and proposed as a criterion for determining who should be offered drug therapy to prevent osteoporotic fracture, even if their hip BMD T score is > −2.5. Previously published studies of the relationships between prior wrist fracture and incident hip and vertebral fractures did not adjust for BMD. Materials and Methods:We ascertained prior history of wrist fracture since age 50, measured calcaneal and hip BMD, and performed lateral spine films in a cohort of 9704 elderly community-dwelling women, and then followed them prospectively for incident vertebral and hip fractures. Incident vertebral fractures were defined by morphometry using lateral spine radiography at the first examination and an average of 3.7 years later. Incident hip fractures were confirmed with radiographic reports over a mean follow-up period of 10.1 years. Results: Prior wrist fracture was associated with an age-adjusted 72% increased odds of incident radiographic vertebral fracture (odds ratio [OR], 1.72; 95% CI, 1.31-2.25). After adjustment for calcaneal BMD, the association of prior wrist fracture with incident radiographic vertebral fracture was attenuated (OR, 1.39; 95% CI, 1.05-1.83). Prior wrist fracture was also associated with an age-adjusted 43% excess rate of incident hip fracture (hazards ratio [HR], 1.43; 95% CI, 1.17-1.74). After adjustment for hip BMD, the association of prior wrist fracture with rate of incident hip fracture was no longer statistically significant (HR, 1.12; 95% CI, 0.92-1.38). Conclusion:In elderly women, prior wrist fracture is a risk factor for radiographic vertebral fracture independent of BMD. The association between prior wrist fracture and incident hip fracture is largely explained by hip BMD. Modest adjustment of BMD drug treatment thresholds for prevention of osteoporotic fractures in those with prior wrist fracture compared with those without prior wrist fracture may be reasonable, but validation of such an approach would require intervention trials in patients with prior wrist fracture.

Guidelines for the diagnosis of osteoporosis: T-scores vs fractures

“…It is important to stress, however, that the diagnosis of osteoporosis can be made based on the presence of a fragility (low-trauma) fracture, regardless of the level of the T-score, which is the manner in which osteoporosis was diagnosed before the WHO criteria were developed. Fractures that are predictive of a higher risk for [27] future fracture in population studies as well as placebo arms of pharmacological clinical trials are: vertebral fractures (VCF), hip fractures, wrist and forearm fractures, humeral and shoulder fractures, and rib fractures [43][44][45][46][47][48][49][50][51]. Fragility fractures at these sites are predictive of future fracture risk independent of the BMD.…”

Osteoporoseprävalenz und assoziierte Versorgungsmuster bei Frauen im Alter ab 45 Jahren in Deutschland

“…Frau en mit stark er nied rig ter Kno chendich te ha ben ein ho hes Ri si ko für os teo poro ti sche Wir be lein brü che [7,24,35]. Dies gilt ins be son de re dann, wenn sich schon an de re Fra gi li täts frak tu ren er eig net ha ben.…”

Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people

“…More recently, two large cohort studies have evaluated the RR of prior wrist fracture for subsequent hip fracture. Although results from a clinical cohort study (mean age, 63) indicated that prior wrist fracture was not significantly associated with subsequent hip fractures (adjusted HR, 1.29) [21], a population-based cohort study (mean age, 72) showed a significant association (age-adjusted odds ratio, 1.43) [20]. Results from these two studies and our study suggest that an association between prior upper limb fracture and subsequent hip fracture may be stronger in older populations.…”

“…In peri-and postmenopausal women specifically, the relative risk of prior fractures at wrist, vertebral, and hip for subsequent hip fracture was 1.9, 2.3, The present study is the first to demonstrate the importance of lower limb fractures at sites other than the hip in predicting future hip fracture. One possible explanation for this result is that hip fracture and other leg bone fractures may share a same cause (i.e., low bone mass) [20]. In addition, prior leg fracture may be associated with the tendency to fall and the subsequent increase in hip fracture risk.…”