Current criteria for hip fracture risk assessment--are we missing something?
BACKGROUND
Hip fracture rates are increasing worldwide, and the risk for a second hip fracture is high. The decision to administer antiresorptive treatment is based mainly on bone mineral density and/or a history of previous osteoporotic fractures.


OBJECTIVE
To evaluate the contribution of BMD, previous fractures, clinical and laboratory parameters to hip fracture risk assessment.


METHODS
The study population included 113 consecutive hip fracture patients, aged 72.5 +/- 9.4 years, discharged from the orthopedic surgery department. BMD was assessed at the lumbar spine, femoral neck and total hip. The results were expressed in standard deviation scores as T-scores--compared to young adults and Z-scores--compared to age-matched controls. Plasma or serum levels of parathyroid hormone, 25-hydroxyvitamin 3 and urinary deoxypyridinoline cross-links were evaluated.


RESULTS
We observed T-scores < or = 2.5 in 43 patients (45.3%) at the lumbar spine, in 47 (52.2%) at the femoral neck and in 33 (38%) at the total hip. Twenty-eight patients (29.5%) had neither low BMD nor previous osteoporotic fractures. Using a T-score cutoff point of (-1.5) at any measurement site would put 25 (89%) of these patients into the high fracture risk group. Mean DPD level was 15.9 +/- 5.8 ng/mg (normal 4-7.3 ng/mg creatinine). Vitamin D inadequacy was observed in 99% of patients.


CONCLUSIONS
Using current criteria, about one-third of elderly hip fracture patients might not have been diagnosed as being at risk. Lowering the BMD cutoff point for patients with additional risk factors may improve risk prediction yield.
Segal
Elena
E
Metabolic Bone Diseases Unit, Rambam Medical Center, Haifa, Israel. e_segals@rambam.health.gov.il
Zinman
Chaim
C
Raz
Batia
B
Ish-Shalom
Sophia
S
D015650:24,25-Dihydroxyvitamin D 3 / Q000097:blood; D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000652:urine; D015519:Bone Density; D005260:Female; D006620:Hip Fractures / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
D000596:Amino Acids; D010281:Parathyroid Hormone; D015650:24,25-Dihydroxyvitamin D 3; C036020:deoxypyridinoline