Non-Hip Peripheral Osteoporotic Fractures: Epidemiology and Significance
Fractures are the most serious consequence of osteoporosis. Non-vertebral and non-hip fractures are seldom recognised as important, even though they account for the majority of all fractures. The most prevalent localisations are distal radius, proximal humerus, ribs, clavicle, and the pelvis. According to the results from large phase III clinical trials for placebo groups, their incidence ranges from 4.9 % to 12.0 %. Hospital morbidity data in Croatia in 2006 show that peripheral non-hip fractures ranked among the leading fifteen injuries, accounting for 23.7 % of all injuries in patients aged 60 years and above. Risk factors for non-hip and non-vertebral fractures are similar to other osteoporotic fractures, and the main are low bone mineral density and earlier fractures. Quality of life is considerably affected by these fractures, and medical costs are very high, soaring as high as 36.9% of all national medical costs in the USA. Non-vertebral non-hip fractures need more attention, which was also recognised by the European regulatory bodies that approve use of anti-osteoporotic drugs.
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Becker C Crow S Toman J Lipton C McMahon DJ Macaulay W Siris E Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors fracture type gender and ethnicity. Osteoporosis Int 2006;17:410-6.
Kanis JA Johnell O Oden A Dawson A De Laet C Jonsson B Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001;12:989-95.
Stone KL Seeley DG Lui LY Cauley JA Ensrud K Browner WS Nevitt MC Cummings SR BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 2003;18:1947-54.
Nguyen TV Center JR Sambrook PN Eisman JA Risk factors for proximal humerus forearm and wrist fractures in elderly men and women: The Dubbo Osteoporosis Epidemiology Study. Am J Epidemiol 2001;153:587-95.
Lee Sh Dargent-Molina P Breart G Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 2002;17:817-25.
Siris ES Chen YT Abbott TA Barrett-Connor E Miller PD Wehren LE Berger ML Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 2004;164:1108-12.
Schuit SC van der Klift M Weel AE de Laet CE Burger H Seeman E Hofman A Uitterlinden AG van Leeuwen JP Pols HA Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 2004;34:195-202.
Gallacher SJ McQuillian C Harkness M Finlay F Gallagher AP Dixon T Prevalence of vitamin D inadequacy in Scottish adults with non-vertebral fragility fractures. Curr Med Res Opin 2005;21:1355-61.
Klotzbuecher CM Ross PD Landsman PB Abbott TA 3rd Berger M Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000;15:721-39.
Delmas PD Genant HK Crans GG Stock JL Wong M Siris E Adachi JD Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 2003;33:522-32.
Cuddihy MT Gabriel SE Crowson CS O'Fallon WM Melton III LJ. Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int 1999;9:469-75.
Barrett-Connor E Sajjan SG Siris ES Miller PD Chen YT Markson LE Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 2007 Dec 6 [Epub ahead of print].
Ismail AA Silman AJ Reeve J Kaptoge S O'Neill TW Rib fractures predict incident limb fractures: results from the European prospective osteoporosis study. Osteoporos Int 2006;17:41-5.
Matković V Kostial K Simonović I Buzina R Brodarec A Nordin BE Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 1979;32:540-9.
Johnell O Kanis JA Odén A Sernbo I Redlund-Johnell I Petterson C De Laet C Jönsson B Mortality after osteoporotic fractures. Osteoporos Int 2004:15:38-42.
Cauley JA Thompson DE Ensrud KC Scott JC Black D Risk of mortality following clinical fractures. Osteoporos Int 2000;11:556-61.
Melton III LJ Gabriel SE Crowson CS Tosteson AN Johnell O Kanis JA Cost-equivalence of different osteoporotic fractures. Osteoporos Int 2003;14:383-8.
National Health Board Sweden Annual Report 2002.
Zethraeus N Ben Sedrine W Caulin F Corcaud S Gathon HJ Haim M Johnell O Jönsson B Kanis JA Tsouderos Y Reginster JY Models for assessing the cost-efectivness of the treatment and prevention of osteoporosis. Osteoporos Int 2002;13:841-57.
Ray NF Chan JK Thamer M Melton LJ III. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997;12:24-35.
Committee for Medicinal Products for Human Use. Guideline on the evaluation of medicinal products in the treatment of primary osteoporosis. CPMP/EWP/552/95 Rev. 2. [displayed 21 January 2008] Available at http://www.emea.europa.eu/htms/human/humanguidelines/efficacy.htm
Kanis JA Johnell O Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 2005;16:229-38.
Johnell O Kanis J Epidemiology of osteoporotic fractures. Osteoporos Int 2005;16(Suppl 2):S3-7.
Kanis JA Johnell O Oden A Sembo I Redlund-Johnell I Dawson A De Laet C Jonsson B Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 2000;11:669-74.
Eastell R Reid DM Compston J Cooper C Fogelman I Francis RM Hay SM Hosking DJ Purdie DW Ralston SH Reeve J Russell RG Stevenson JC Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action? QJM 2001;94:575-97.
Delmas PD Ensrud KE Adachi JD Harper KD Sarkar S Gennari C Reginster JY Pols HA Recker RR Harris ST Wu W Genant HK Black DM Eastell R Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002;87:3609-17.
Black DM Thompson DE Bauer DC Ensrud K Musliner T Hochberg MC Nevitt MC Suryawanshi S Cummings SR Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. (erratum in J Clin Endocrinol Metab 2001;86:938). J Clin Endocrinol Metab 2000;85:4118-24.
McClung MR Geusens P Miller PD Zippel H Bensen WG Roux C Adami S Fogelman I Diamond T Eastell R Meunier PJ Reginster JY Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001;344:333-40.
Neer RM Arnaud CD Zanchetta JR Prince R Gaich GA Reginster JY Hodsman AB Eriksen EF Ish-Shalom S Genant HK Wang O Mitlak BH Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001;344:1434-41.
Donaldson LJ Cook A Thomson RG Incidence of fractures in a geographically defined population. J Epidemiol Community Health 1990;44:241-5.
van Staa TP Dennison EM Leufkens HG Cooper C Epidemiology of fractures in England and Wales. Bone 2001;29:517-22.
Melton LJ III. Epidemiology of fractures. In: Riggs BL Melton LJ III editors. Osteoporosis: etiology diagnosis and management. 2nd ed. Philadelphia-New York: Lippincott-Raven; 1995. p. 225-47.
O'Neill TW Grazio S Spector TD Silman AJ Geometric measurement of the proximal femur in UK women: secular increase between the late 1950s and early 1990s. Osteoporosis Int 1996;6:136-40.
Palvanen M Kannus P Niemi S Parkkari J Update in the epidemiology of the proximal humeral fractures. Clin Orthop Relat Res 2006;442:87-92.
Croatian National Institute of Public Health. Croatian Health Service Yearbook 2006. [displayed 2007]. Available at http://www.hzjz.hr