Which Fractures Are Associated with Low Appendicular Bone Mass in Elderly Women?

TLDR

The study aimed to identify fracture types with higher incidence in elderly women with low appendicular bone mass. A prospective cohort of 9,704 ambulatory nonblack women aged ≥65 years was followed for 2.23 years, with bone mass measured at the distal and proximal radius and calcaneus by single‑photon absorptiometry and fractures verified radiographically; age‑adjusted hazard ratios per SD decrease in bone mass were calculated. Lower appendicular bone mass was linked to higher risk of wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle fractures—accounting for 74% of nonspinal fractures—with an overall hazard ratio of 1.65 at the distal radius; vertebral fractures were also associated, whereas ankle, elbow, finger, and face fractures were not.

Abstract

To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass.Prospective cohort study.Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California.Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings.We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% Cls) per standard deviation decrease in bone mass.During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P less than 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius.Most types of fractures have an increased incidence in elderly women with low bone mass.