Clinical and demographic factors associated with fractures among older Americans

Abstract

Purpose This study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies. Methods We used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005. Results For each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African Americans for all sites except ankle and tibia/fibula, which were lowest among Asian Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture. Conclusions This study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.

Fraturas de fêmur em idosos no Brasil: análise espaço-temporal de 2008 a 2012

“…Embora metodologicamente o estudo não permita afirmar as razões para e sobre essas diferenças, este foi um achado bastante interessante que levanta a possibilidade de que possíveis disparidades intrínsecas e extrínsecas, relacionadas a aspectos geográficos e climáticos, além de variações nos hábitos alimentares e até mesmo diferentes ações em saúde, instituídas de forma regionalizadas, poderiam influenciar a ocorrência das fraturas de fêmur e/ou de seus fatores de risco, como por exemplo, a osteoporose. Outros autores também relataram diferenças espaciais nas ocorrências de fraturas de fêmur, como Taylor et al 30 , ao observarem que a taxa de fraturas de fêmur nos Estados Unidos é maior na Região Sul do que nas demais regiões, dado atribuído à variação geográfica verdadeira na incidência de fraturas ou a diferenças na sua detecção. Estudo realizado por Lalmohamed et al 36 encontrou maior incidência de fraturas de fêmur nos países europeus do que na China, México e países na área do Mediterrâneo.…”

Epidemiology of forearm fractures in adults in Denmark: national age- and gender-specific incidence rates, ratio of forearm to hip fractures, and extent of surgical fracture repair in inpatients and outpatients

“…Women living in urban areas had lower body mass index, lower forearm BMD, higher alcohol and tobacco consumption, and had a lower number of childbirths, all of which could contribute to the differences. Similarly, in the US, rates of forearm fractures are also significantly higher in urban areas and lower in the Western US than in the South, Northeast, or Midwest [14]. Forearm fractures are common [2], costly [15,16], and to a large extent preventable by antiresorptive treatment, at least in postmenopausal women [17].…”

Declining Rates of Osteoporosis Management Following Fragility Fractures in the U.S., 2000 Through 2009

“…We selected these four anatomical sites because they represent the four most common locations of fragility fractures in older individuals in the U.S. and are the most strongly associated with increasing age 6 . We focused on incident fractures by identifying the first occurrence of such a fracture within the study period (''index'' fracture) and excluding individuals with evidence of any other fragility fracture in the twelve months before the index fracture.…”