title: Bone and fall-related fracture risks in women and men with a recent clinical fracture.
abstract: BACKGROUND
  Worldwide fracture rates are increasing as a result of the aging population, and prevention, both primary and secondary, is an important public health goal. Therefore, we systematically analyzed risk factors in subjects with a recent clinical fracture.
  
  
  METHODS
  All men and women over fifty years of age who had been treated in the emergency department of, or hospitalized at, our institution because of a recent fracture during a one-year period were offered the opportunity to undergo an evidence-based bone and fall-related risk-factor assessment and bone densitometry. The women included in this study were also compared with a group of postmenopausal women without a fracture history who had been included in another cohort study.
  
  
  RESULTS
  Of the 940 consecutive patients, 797 (85%) were eligible for this study and 568 (60%) agreed to participate. The prevalence of fall-related risk factors (75% [95% confidence interval = 71% to 78%]; n = 425) and the prevalence of bone-related risk factors (53% [95% confidence interval = 49% to 57%]; n = 299) at the time of fracture were higher than the prevalence of osteoporosis (35% [95% confidence interval = 31% to 39%]; n = 201) as defined by a dual x-ray absorptiometry T score of <or=-2.5 in the spine and/or hip. The fall and bone-related risk factors were present irrespective of the fracture location, patient age, or gender. An overlap between bone and fall-related risk factors was found in 50% of the patients. After adjusting for age, weight, and height, we found that women with a fracture more frequently had a diagnosis of osteoporosis (odds ratio = 2.9; 95% confidence interval = 2.0 to 4.1) and had a more extensive history of falls (odds ratio = 4.0; 95% confidence interval = 2.7 to 5.9) than did the postmenopausal women without a fracture history.
  
  
  CONCLUSIONS
  Men and women over fifty years of age who had recently sustained a clinical fracture had, at the time of that fracture, bone and fall-related risk factors that were greater than the risk predicted by the presence of osteoporosis. Risk factors were overlapping, heterogeneous, and found in multiple combinations. This was the case regardless of the patient's age, fracture location, or gender. These findings suggest that an integrated bone and fall-related risk-factor assessment is a preferable means for identifying elderly subjects at risk for fracture. Integrated bone and fall-related risk assessment and treatment studies are needed to document this proposal.
authors.affiliation: Department of General Surgery and Trauma Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. svhl@surgery.azm.nl
authors.forename: Svenhjalmar
authors.initials: S
authors.lastname: van Helden
authors.forename: Antonia C M
authors.initials: AC
authors.lastname: van Geel
authors.forename: Piet P
authors.initials: PP
authors.lastname: Geusens
authors.forename: Alfons
authors.initials: A
authors.lastname: Kessels
authors.forename: Arie C
authors.initials: AC
authors.lastname: Nieuwenhuijzen Kruseman
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors