Fractures
Bone density loss from osteoporosis is a major cause of disability and death in the elderly, mostly due to subsequent fractures. The lifetime risk of spinal fracture in women is about one in three, and that for hip fracture is one in six. Women at highest risk for fractures are those with low bone density plus a history of fractures, particularly nonviolent fractures.
Each year, there are an estimated 500,000 spinal fractures, 300,000 hip fractures, 200,000 broken wrists and 300,000 fractures of other bones. About 80% of these fractures occur after relatively minor falls or accidents.
Between 25% and 60% of women older than 60 develop spinal compression fractures. Studies on men with osteoporosis report that they have a 6% risk for hip fracture and between 16% and 25% risk for any fractures related to osteoporosis.
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Click the icon to see an image of a compression fracture. |
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Click the icon to see an image of a hip fracture. |
Unfortunately, studies continue to report inadequate treatment after a fracture. In a major 2003 study, for example, only 8.4% of women who had sustained fractures were tested for osteoporosis. Worse, less than half of these women received any treatment for osteoporosis. Overall, in the study less than 4% of men and half of women who had sustained fractures were evaluated and treated according to recommended guidelines. The older a woman was, the less likely she was to have adequate treatment.
Risk Factors for Fracture and Falling. The risk for fracture itself in people with low bone density is compounded by certain features. Having multiple risk factors for osteoporosis itself poses a higher risk for fractures. Of note, not all older women with osteoporosis develop fractures. There is some evidence that the body partially compensates after menopause by increasing bone strength, which can help offset the risk for fracture.
Falling, of course, is the primary risk factor for fracture.
So, of course, additional risk factors for fracture are those that increase the risk for falling. They include the following:
- Having chronic medical problems (notably emphysema, heart disease, stroke, arthritis, and depression), with the risk increasing with multiple health problems. Such problems may account for 30% of falls in older women.
- Taking multiple medications (notably tranquilizers and antidepressants).
- Poor physical function, importantly slow gait and reduced muscle strength. Inactivity that results in weak thigh muscles and poor balance particularly puts any older person at risk for fracture and particularly those with low bone density. One study conducted in a rural part of Turkey where women did more physical work showed that men had a higher rate of fractures than women.
- Poor concentration or mental impairment.
- Impaired vision.
- Hazardous environment (such as the presence of throw rugs in the house).
Mortality Rates After Fracture
Between 25% and 36% of women who experience a hip fracture die within a year afterward and about a quarter of the patients require nursing home treatment. The mortality rates after major fractures may be even higher in older men than in older women. Mortality rates after hip fractures declined from the 1960s through the early 1980s, but they have since leveled off. It is possible that little more can be done to improve these mortality rates, since people at highest risk for falling and fractures are elderly and often have multiple chronic health problems. Whether or not medical advances can improve mortality rates in the future, prevention of osteoporosis is extremely important.
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