Post‐fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT
ABSTRACT The location of osteoporotic fragility fractures adds crucial information to post‐fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The obj...
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| creator | Borgen, Tove T Bjørnerem, åshild Solberg, Lene B Andreasen, Camilla Brunborg, Cathrine Stenbro, May‐Britt Hübschle, Lars M Froholdt, Anne Figved, Wender Apalset, Ellen M Gjertsen, Jan‐Erik Basso, Trude Lund, Ida Hansen, Ann K Stutzer, Jens‐Meinhard Omsland, Tone K Nordsletten, Lars Frihagen, Frede Eriksen, Erik F |
| description | ABSTRACT
The location of osteoporotic fragility fractures adds crucial information to post‐fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross‐sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men ≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoral neck, total hip, and lumbar spine assessed using dual‐energy X‐ray absorptiometry (DXA), trabecular bone score (TBS) calculated, concomitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire concerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus 827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1‐SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (all p |
| doi_str_mv | 10.1002/jbmr.3827 |
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The location of osteoporotic fragility fractures adds crucial information to post‐fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross‐sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men ≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoral neck, total hip, and lumbar spine assessed using dual‐energy X‐ray absorptiometry (DXA), trabecular bone score (TBS) calculated, concomitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire concerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus 827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1‐SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (all p < 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with central fragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patients with peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure, translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fracture prevention, although attention to peripheral fractures should still not be diminished. © 2019 American Society for Bone and Mineral Research. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Fractures at central sites are associated with lower BMD at the femoral neck, total hip, and the site with lowest T‐score, lower TBS, and higher prevalence of vertebral fractures. BMD = bone mineral density; TBS = trabecular bone score.</description><identifier>ISSN: 0884-0431</identifier><identifier>EISSN: 1523-4681</identifier><identifier>DOI: 10.1002/jbmr.3827</identifier><identifier>PMID: 31310352</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; Ankle ; Body mass index ; Bone Density ; BONE MINERAL DENSITY ; Cancellous bone ; Cross-Sectional Studies ; Dual energy X-ray absorptiometry ; Femur ; Forearm ; Fractures ; Hip ; Humans ; Humerus ; Norway ; OSTEOPOROSIS ; Osteoporotic Fractures - epidemiology ; Osteoporotic Fractures - metabolism ; Osteoporotic Fractures - prevention & control ; Pelvis ; Prevalence ; Risk Assessment ; Risk Factors ; Spinal Fractures - epidemiology ; Spinal Fractures - metabolism ; Spinal Fractures - prevention & control ; Spine (lumbar) ; Surveys and Questionnaires ; TRABECULAR BONE SCORE ; Vertebrae ; VERTEBRAL FRACTURE ASSESSMENT ; VERTEBRAL FRACTURES</subject><ispartof>Journal of bone and mineral research, 2019-11, Vol.34 (11), p.2036-2044</ispartof><rights>2019 The Authors. published by American Society for Bone and Mineral Research</rights><rights>2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.</rights><rights>2019 American Society for Bone and Mineral Research</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3037-5387162ed9963b4cafcd4cceb32d3922e827c2951231d16c77a33e7f06ecd0be3</citedby><cites>FETCH-LOGICAL-c3037-5387162ed9963b4cafcd4cceb32d3922e827c2951231d16c77a33e7f06ecd0be3</cites><orcidid>0000-0002-5012-0903</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjbmr.3827$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjbmr.3827$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31310352$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Borgen, Tove T</creatorcontrib><creatorcontrib>Bjørnerem, åshild</creatorcontrib><creatorcontrib>Solberg, Lene B</creatorcontrib><creatorcontrib>Andreasen, Camilla</creatorcontrib><creatorcontrib>Brunborg, Cathrine</creatorcontrib><creatorcontrib>Stenbro, May‐Britt</creatorcontrib><creatorcontrib>Hübschle, Lars M</creatorcontrib><creatorcontrib>Froholdt, Anne</creatorcontrib><creatorcontrib>Figved, Wender</creatorcontrib><creatorcontrib>Apalset, Ellen M</creatorcontrib><creatorcontrib>Gjertsen, Jan‐Erik</creatorcontrib><creatorcontrib>Basso, Trude</creatorcontrib><creatorcontrib>Lund, Ida</creatorcontrib><creatorcontrib>Hansen, Ann K</creatorcontrib><creatorcontrib>Stutzer, Jens‐Meinhard</creatorcontrib><creatorcontrib>Omsland, Tone K</creatorcontrib><creatorcontrib>Nordsletten, Lars</creatorcontrib><creatorcontrib>Frihagen, Frede</creatorcontrib><creatorcontrib>Eriksen, Erik F</creatorcontrib><title>Post‐fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT</title><title>Journal of bone and mineral research</title><addtitle>J Bone Miner Res</addtitle><description>ABSTRACT
The location of osteoporotic fragility fractures adds crucial information to post‐fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross‐sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men ≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoral neck, total hip, and lumbar spine assessed using dual‐energy X‐ray absorptiometry (DXA), trabecular bone score (TBS) calculated, concomitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire concerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus 827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1‐SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (all p < 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with central fragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patients with peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure, translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fracture prevention, although attention to peripheral fractures should still not be diminished. © 2019 American Society for Bone and Mineral Research. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Fractures at central sites are associated with lower BMD at the femoral neck, total hip, and the site with lowest T‐score, lower TBS, and higher prevalence of vertebral fractures. BMD = bone mineral density; TBS = trabecular bone score.</description><subject>Aged</subject><subject>Ankle</subject><subject>Body mass index</subject><subject>Bone Density</subject><subject>BONE MINERAL DENSITY</subject><subject>Cancellous bone</subject><subject>Cross-Sectional Studies</subject><subject>Dual energy X-ray absorptiometry</subject><subject>Femur</subject><subject>Forearm</subject><subject>Fractures</subject><subject>Hip</subject><subject>Humans</subject><subject>Humerus</subject><subject>Norway</subject><subject>OSTEOPOROSIS</subject><subject>Osteoporotic Fractures - epidemiology</subject><subject>Osteoporotic Fractures - metabolism</subject><subject>Osteoporotic Fractures - prevention & control</subject><subject>Pelvis</subject><subject>Prevalence</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spinal Fractures - epidemiology</subject><subject>Spinal Fractures - metabolism</subject><subject>Spinal Fractures - prevention & control</subject><subject>Spine (lumbar)</subject><subject>Surveys and Questionnaires</subject><subject>TRABECULAR BONE SCORE</subject><subject>Vertebrae</subject><subject>VERTEBRAL FRACTURE ASSESSMENT</subject><subject>VERTEBRAL FRACTURES</subject><issn>0884-0431</issn><issn>1523-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kM2O0zAQgC3EinYLB14AGXFhD9m1PYmd7K1UdH9UftQtZytxJpCSNMXjaNUbj7DPyJNsSgsHJE6WRt98Gn-MvZTiXAqhLtZF688hVeYJG8tEQRTrVD5lY5GmcSRikCN2SrQWQuhE62dsBBKkgESNWfG5o_Dr50Plcxd6j3xZ03c-JUKiFjfhkq9y_xUDD9-Qz4aBz5tmx-_qgCWfH5eIz2tP4TWf8ru-oNCXO95V_GM3X05nq-fspMobwhfHd8K-zN-vZtfR4tPVzWy6iBwIMFECqZFaYZllGorY5ZUrY-ewAFVCphQO_3MqS6QCWUrtjMkB0FRCoytFgTBhbw_ere9-9EjBtjU5bJp8g11PVqkkNWBMKgf0zT_ouuv9ZrjODnbIjNIyHqizA-V8R-Sxsltft7nfWSnsPrzdh7f78AP76mjsixbLv-Sf0gNwcQDu6wZ3_zfZ23cflr-Vjz_mjMA</recordid><startdate>201911</startdate><enddate>201911</enddate><creator>Borgen, Tove T</creator><creator>Bjørnerem, åshild</creator><creator>Solberg, Lene B</creator><creator>Andreasen, Camilla</creator><creator>Brunborg, Cathrine</creator><creator>Stenbro, May‐Britt</creator><creator>Hübschle, Lars M</creator><creator>Froholdt, Anne</creator><creator>Figved, Wender</creator><creator>Apalset, Ellen M</creator><creator>Gjertsen, Jan‐Erik</creator><creator>Basso, Trude</creator><creator>Lund, Ida</creator><creator>Hansen, Ann K</creator><creator>Stutzer, Jens‐Meinhard</creator><creator>Omsland, Tone K</creator><creator>Nordsletten, Lars</creator><creator>Frihagen, Frede</creator><creator>Eriksen, Erik F</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TS</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5012-0903</orcidid></search><sort><creationdate>201911</creationdate><title>Post‐fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT</title><author>Borgen, Tove T ; Bjørnerem, åshild ; Solberg, Lene B ; Andreasen, Camilla ; Brunborg, Cathrine ; Stenbro, May‐Britt ; Hübschle, Lars M ; Froholdt, Anne ; Figved, Wender ; Apalset, Ellen M ; Gjertsen, Jan‐Erik ; Basso, Trude ; Lund, Ida ; Hansen, Ann K ; Stutzer, Jens‐Meinhard ; Omsland, Tone K ; Nordsletten, Lars ; Frihagen, Frede ; Eriksen, Erik F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3037-5387162ed9963b4cafcd4cceb32d3922e827c2951231d16c77a33e7f06ecd0be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Ankle</topic><topic>Body mass index</topic><topic>Bone Density</topic><topic>BONE MINERAL DENSITY</topic><topic>Cancellous bone</topic><topic>Cross-Sectional Studies</topic><topic>Dual energy X-ray absorptiometry</topic><topic>Femur</topic><topic>Forearm</topic><topic>Fractures</topic><topic>Hip</topic><topic>Humans</topic><topic>Humerus</topic><topic>Norway</topic><topic>OSTEOPOROSIS</topic><topic>Osteoporotic Fractures - epidemiology</topic><topic>Osteoporotic Fractures - metabolism</topic><topic>Osteoporotic Fractures - prevention & control</topic><topic>Pelvis</topic><topic>Prevalence</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spinal Fractures - epidemiology</topic><topic>Spinal Fractures - metabolism</topic><topic>Spinal Fractures - prevention & control</topic><topic>Spine (lumbar)</topic><topic>Surveys and Questionnaires</topic><topic>TRABECULAR BONE SCORE</topic><topic>Vertebrae</topic><topic>VERTEBRAL FRACTURE ASSESSMENT</topic><topic>VERTEBRAL FRACTURES</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Borgen, Tove T</creatorcontrib><creatorcontrib>Bjørnerem, åshild</creatorcontrib><creatorcontrib>Solberg, Lene B</creatorcontrib><creatorcontrib>Andreasen, Camilla</creatorcontrib><creatorcontrib>Brunborg, Cathrine</creatorcontrib><creatorcontrib>Stenbro, May‐Britt</creatorcontrib><creatorcontrib>Hübschle, Lars M</creatorcontrib><creatorcontrib>Froholdt, Anne</creatorcontrib><creatorcontrib>Figved, Wender</creatorcontrib><creatorcontrib>Apalset, Ellen M</creatorcontrib><creatorcontrib>Gjertsen, Jan‐Erik</creatorcontrib><creatorcontrib>Basso, Trude</creatorcontrib><creatorcontrib>Lund, Ida</creatorcontrib><creatorcontrib>Hansen, Ann K</creatorcontrib><creatorcontrib>Stutzer, Jens‐Meinhard</creatorcontrib><creatorcontrib>Omsland, Tone K</creatorcontrib><creatorcontrib>Nordsletten, Lars</creatorcontrib><creatorcontrib>Frihagen, Frede</creatorcontrib><creatorcontrib>Eriksen, Erik F</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and mineral research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Borgen, Tove T</au><au>Bjørnerem, åshild</au><au>Solberg, Lene B</au><au>Andreasen, Camilla</au><au>Brunborg, Cathrine</au><au>Stenbro, May‐Britt</au><au>Hübschle, Lars M</au><au>Froholdt, Anne</au><au>Figved, Wender</au><au>Apalset, Ellen M</au><au>Gjertsen, Jan‐Erik</au><au>Basso, Trude</au><au>Lund, Ida</au><au>Hansen, Ann K</au><au>Stutzer, Jens‐Meinhard</au><au>Omsland, Tone K</au><au>Nordsletten, Lars</au><au>Frihagen, Frede</au><au>Eriksen, Erik F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Post‐fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT</atitle><jtitle>Journal of bone and mineral research</jtitle><addtitle>J Bone Miner Res</addtitle><date>2019-11</date><risdate>2019</risdate><volume>34</volume><issue>11</issue><spage>2036</spage><epage>2044</epage><pages>2036-2044</pages><issn>0884-0431</issn><eissn>1523-4681</eissn><abstract>ABSTRACT
The location of osteoporotic fragility fractures adds crucial information to post‐fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross‐sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men ≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoral neck, total hip, and lumbar spine assessed using dual‐energy X‐ray absorptiometry (DXA), trabecular bone score (TBS) calculated, concomitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire concerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus 827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1‐SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (all p < 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with central fragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patients with peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure, translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fracture prevention, although attention to peripheral fractures should still not be diminished. © 2019 American Society for Bone and Mineral Research. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Fractures at central sites are associated with lower BMD at the femoral neck, total hip, and the site with lowest T‐score, lower TBS, and higher prevalence of vertebral fractures. BMD = bone mineral density; TBS = trabecular bone score.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>31310352</pmid><doi>10.1002/jbmr.3827</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5012-0903</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of bone and mineral research, 2019-11, Vol.34 (11), p.2036-2044 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Ankle Body mass index Bone Density BONE MINERAL DENSITY Cancellous bone Cross-Sectional Studies Dual energy X-ray absorptiometry Femur Forearm Fractures Hip Humans Humerus Norway OSTEOPOROSIS Osteoporotic Fractures - epidemiology Osteoporotic Fractures - metabolism Osteoporotic Fractures - prevention & control Pelvis Prevalence Risk Assessment Risk Factors Spinal Fractures - epidemiology Spinal Fractures - metabolism Spinal Fractures - prevention & control Spine (lumbar) Surveys and Questionnaires TRABECULAR BONE SCORE Vertebrae VERTEBRAL FRACTURE ASSESSMENT VERTEBRAL FRACTURES |
| title | Post‐fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT |
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