Epidemiology and outcomes of osteoporotic fractures

Cummings, Steven R.; Melton, L. Joseph

doi:10.1016/s0140-6736(02)08657-9

Cited by 3,150 publications

(2,179 citation statements)

References 83 publications

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“…Similar figures have been reported for other countries in Europe and as the population is growing older the total number of hip fractures is expected to rise 2. Patients suffering hip fractures often have multiple comorbidities and mortality and morbidity is high even though a hip fracture most commonly is a result of a low‐energy trauma 3.…”

Section: Introductionsupporting

confidence: 62%

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Jonsson

Bentzer

Turkiewicz

et al. 2018

Acta Anaesthesiol Scand

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BackgroundLittle is known about accuracy of common risk prediction scores in elderly patients suffering from hip fractures. The objective of this study was to investigate accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, Portsmouth‐POSSUM (P‐POSSUM) score and the Nottingham Hip Fracture Score (NHFS) for prediction of mortality and morbidity in this patient group.MethodsThis was a prospective single centre observational study on 997 patients suffering out‐of‐hospital cervical, trochanteric or subtrochanteric fracture of the neck of the femur. Calibration and discrimination was assessed by calculating the ratio of observed to expected events (O:E) and areas under receiver operating characteristics curves (ROC).ResultsThe 30‐day mortality was 6.2% and complications, as defined by POSSUM, occurred in 41% of the patients. Overall O:E ratios for POSSUM, P‐POSSUM and NHFS scores for 30‐day mortality were 0.90, 0.98, and 0.79 respectively. The models underestimated mortality in the lower risk bands and overestimated mortality in the higher risk bands. In contrast, POSSUM predicted morbidity well with O:E ratios close to unity in most risk bands. The areas under the ROC curves for the scoring systems was 0.60‐0.67.ConclusionThe POSSUM score and NHFS show moderate calibration and poor discrimination in this cohort. The results suggest that mortality and morbidity in hip fracture patients are largely dependent on factors that are not included in these scores.

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Section: Introductionsupporting

confidence: 62%

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Jonsson

Bentzer

Turkiewicz

et al. 2018

Acta Anaesthesiol Scand

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“…Under physiological conditions, plasma AOPP concentration is relatively low while increases with aging (Komosinska‐Vassev et al., 2012; Zhang et al., 2011). Osteoporosis is a common skeletal disease in aged and is characterized by low bone mass and microstructure deterioration of bone tissue (Cummings & Melton, 2002; Ford, Bass, Zhao, Bai & Zhao, 2011; Reginster & Burlet, 2006). Numerous studies have proven that osteoporosis was associated with a higher oxidative stress index values and total plasma oxidant status (Almeida & O'Brien, 2013; Sendur, Turan, Tastaban & Serter, 2009; Zhang et al., 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, one in three women over the age of 50 years and one in five men at the same age will experience osteoporotic fractures in their lifetime (Brown, 2017). Osteoporosis is increasingly being recognized as an important cause of morbidity and mortality in the elderly population (Cummings & Melton, 2002; Jilka & O'Brien, 2016). …”

Section: Introductionmentioning

confidence: 99%

Advanced oxidation protein products induce pre‐osteoblast apoptosis through a nicotinamide adenine dinucleotide phosphate oxidase‐dependent, mitogen‐activated protein kinases‐mediated intrinsic apoptosis pathway

et al. 2018

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SummaryOsteoblast apoptosis contributes to age‐related bone loss. Advanced oxidation protein products (AOPPs) are recognized as the markers of oxidative stress and potent inducers of apoptosis. We have demonstrated that AOPP accumulation was correlated with age‐related bone loss. However, the effect of AOPPs on the osteoblast apoptosis still remains unknown. Exposure of osteoblastic MC3T3‐E1 cells to AOPPs caused the excessive generation of reactive oxygen species (ROS) by activating nicotinamide adenine dinucleotide phosphate (NADPH) oxidases. Increased ROS induced phosphorylation of mitogen‐activated protein kinases (MAPKs), which subsequently triggered intrinsic apoptosis pathway by inducing mitochondrial dysfunction, endoplasmic reticulum stress, and Ca2+ overload and eventually leads to apoptosis. Chronic AOPP loading in aged Sprague‐Dawley rats induced osteoblast apoptosis and activated NADPH oxidase signaling cascade, in combination with accelerated bone loss and deteriorated bone microstructure. Our study suggests that AOPPs induce osteoblast apoptosis by the NADPH oxidase‐dependent, MAPK‐mediated intrinsic apoptosis pathway.

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“…M any studies have shown increased fracture risk (1)(2)(3) and mortality (4)(5)(6)(7)(8) after clinical vertebral fracture. Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality.…”

Section: Introductionmentioning

confidence: 98%

Height loss starting in middle age predicts increased mortality in the elderly

Masunari

Fujiwara

Kasagi

et al. 2011

Journal of Bone and Mineral Research

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The purpose of this study was to determine the mortality risk among Japanese men and women with height loss starting in middle age, taking into account lifestyle and physical factors. A total of 2498 subjects (755 men and 1743 women) aged 47 to 91 years old underwent physical examinations during the period 1994 to 1995. Those individuals were followed for mortality status through 2003. Mortality risk was estimated using an age-stratified Cox proportional hazards model. In addition to sex, adjustment factors such as radiation dose, lifestyle, and physical factors measured at the baseline-including smoking status, alcohol intake, total cholesterol, blood pressure, and diagnosed diseases-were used for analysis of total mortality and mortality from each cause of death. There were a total of 302 all-cause deaths, 46 coronary heart disease and stroke deaths, 58 respiratory deaths including 45 pneumonia deaths, and 132 cancer deaths during the follow-up period. Participants were followed for 20,787 person-years after baseline. Prior history of vertebral deformity and hip fracture were not associated with mortality risk. However, more than 2 cm of height loss starting in middle age showed a significant association with all-cause mortality among the study participants (HR ¼ 1.76, 95% CI 1.31 to 2.38, p ¼ 0.0002), after adjustment was made for sex, attained age, atomic-bomb radiation exposure, and lifestyle and physical factors. Such height loss also was significantly associated with death due to coronary heart disease or stroke (HR ¼ 3.35, 95% CI 1.63 to 6.86, p ¼ 0.0010), as well as respiratory-disease death (HR ¼ 2.52, 95% CI 1.25 to 5.22, p ¼ 0.0130), but not cancer death. Continuous HL also was associated with all-cause mortality and CHD-or stroke-caused mortality. Association between height loss and mortality was still significant, even after excluding persons with vertebral deformity. Height loss of more than 2 cm starting in middle age was an independent risk factor for cardiovascular and respiratory-disease mortality among the elderly, even after adjusting for potential risk factors. ß

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Epidemiology and outcomes of osteoporotic fractures

Cited by 3,150 publications

References 83 publications

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Advanced oxidation protein products induce pre‐osteoblast apoptosis through a nicotinamide adenine dinucleotide phosphate oxidase‐dependent, mitogen‐activated protein kinases‐mediated intrinsic apoptosis pathway

Height loss starting in middle age predicts increased mortality in the elderly

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