Risk and Prevention of Fracture in Patients With Major Medical Illnesses: A Mini-Review

Abstract

Patients with several medical conditions, including Parkinson's disease, recent stroke, HIV, and heart failure, have a high risk of hip fracture. These patients will also have more severe consequences of a hip fracture, including a greater chance of dying and more prolonged disability. Together, there are nearly as many patients with medical conditions that substantially increase the risk of hip fracture as there are people with osteoporosis by femoral neck bone mineral density (BMD). The contributions of falling and decreased bone mass to the increased risks with these conditions are not certain. Although there are few data about whether and what type of treatments these patients receive to prevent fracture, it is likely that few receive pharmacologic treatments that have been shown to reduce the risk of hip fracture. There is a need to show that drug treatments that strengthen bone also reduce fracture risk in patients whose risk may be owing in greater part to traumatic falls than osteoporosis. Assuming that treatments are efficacious in these patients, there is a major opportunity to substantially reduce the incidence and consequences of hip fracture by reaching more of them with drug treatments to reduce the risk of hip fracture. This will require engagement of specialists who have little expertise and perhaps limited interest in preventing fractures, or new approaches to delivering drug treatments to prevent fracture directly to the patients at risk.

Impact of Competing Risk of Mortality on Association of Cognitive Impairment With Risk of Hip Fracture in Older Women

“…However, many studies examining the association of potential risk factors with incidence of disease‐related clinical outcomes in the geriatric population often do not take into account the competing risk of death, which can lead to overestimates of incidence of these disease events in this population, particularly if the competing risk of mortality is high. It has previously been suggested that older women with dementia may be at high risk of hip fracture and should be targeted for drug treatment to lower fracture risk . However, our results highlight the importance of consideration of the competing risk of mortality when evaluating potential risk factors such as cognitive impairment as predictors of hip fracture in older adults.…”

“…It has previously been suggested that older women with dementia may be at high risk of hip fracture and should be targeted for drug treatment to lower fracture risk. (8) However, our results highlight the importance of consideration of the competing risk of mortality when evaluating potential risk factors such as cognitive impairment as predictors of hip fracture in older adults.…”

“…This association may be due in part to an increased risk of falls, although other mechanisms may play a role in the association, including effects of medications and limited mobility on bone mineral density (BMD). The increased risk of fractures observed in individuals with dementia has led to calls for consideration of initiation of pharmacologic treatment to improve BMD in patients with dementia to lower fracture risk . However, an individual's life expectancy and the time to benefit of any intervention are important factors in the decision‐making by clinicians and patients, particularly when contemplating a potential intervention in older adults.…”

“…The increased risk of fractures observed in individuals with dementia has led to calls for consideration of initiation of pharmacologic treatment to improve BMD in patients with dementia to lower fracture risk. (8) However, an individual's life expectancy and the time to benefit of any intervention are important factors in the decision-making by clinicians and patients, particularly when contemplating a potential intervention in older adults.…”

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

“…The baseline comorbidities and use of medications which were considered as possible potential confounders (listed in table 1) were selected according to previous studies. [42][43][44][45][46][47][48] The criteria for defining pre-existing comorbidity was the positive diagnosis of any disease either at the time of a minimum of one hospital admission or two outpatient visits within the year prior to the index date. A baseline use of medication was defined as the use of these drugs at least 30 days during the year preceding the index date.…”