Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study.
OBJECTIVE
To study the causes and consequences of radiologically confirmed rib fractures (seldom considered in the context of osteoporosis) in community dwelling older men.


METHODS
Prospective cohort study (Osteoporotic Fractures in Men (MrOS) Study).


METHODS
5995 men aged 65 or over recruited in 2000-2 from six US sites; 99% answered mailed questionnaires about falls and fractures every four months for a mean 6.2 (SD 1.3) year follow-up.


METHODS
New fractures validated by radiology reports; multivariate Cox proportional hazard ratios were used to evaluate factors independently associated with time to incident rib fracture; associations between baseline rib fracture and incident hip and wrist fracture were also evaluated.


RESULTS
The incidence of rib fracture was 3.5/1000 person years, and 24% (126/522) of all incident non-spine fractures were rib fractures. Nearly half of new rib fractures (48%; n=61) followed falling from standing height or lower. Independent risk factors for an incident rib fracture were age 80 or above, low bone density, difficulty with instrumental activities of daily living, and a baseline history of rib/chest fracture. Men with a history of rib/chest fracture had at least a twofold increased risk of an incident rib fracture (adjusted hazard ratio 2.71, 95% confidence interval 1.86 to 3.95), hip fracture (2.05, 1.33 to 3.15), and wrist fracture (2.06, 1.14 to 3.70). Only 14/82 of men reported being treated with bone specific drugs after their incident rib fracture.


CONCLUSIONS
Rib fracture, the most common incident clinical fracture in men, was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture. A history of rib fracture predicted a more than twofold increased risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture.
Barrett-Connor
Elizabeth
E
Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0607, USA. ebarrettconnor@ucsd.edu
Nielson
Carrie M
CM
Orwoll
Eric
E
Bauer
Douglas C
DC
Cauley
Jane A
JA
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology* / Q000503:physiopathology; D012253:Rib Fractures / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology