title: Screening for osteoporosis following non-vertebral fractures in patients aged 50 and older independently of gender or level of trauma energy-a Swiss trauma center approach.
abstract: Screening in a standardized manner for osteoporosis in non-vertebral fracture patients aged 50 and older independently of both gender and level of trauma energy yielded the indication for osteoporotic therapy for every fourth male high-energy fracture patient.
  
  
  OBJECTIVE
  This study aimed to identify the rate of osteoporosis in patients of both genders after fracture independently of the underlying level of trauma energy.
  
  
  METHODS
  A random cohort of patients aged 50 or older with non-vertebral fractures participated in a standardized diagnostic protocol to evaluate the indication for treatment of osteoporosis (number needed to screen (NNS)). Univariate and multivariate analysis as well as correlation testing were performed to determine statistical relationships. Significance was set at p < 0.05.
  
  
  RESULTS
  Of 478 fracture patients with a mean age of 69.3 ± 11.8 years, 317 (66.3%) were female and 161 (33.7%) male. One hundred nineteen patients (24.9%) sustained high-energy fractures (HEFs) and 359 (75.1%) low-energy fractures (LEFs). Twenty-eight percent of males and 47% of females qualified as osteoporotic in densitometry (dual-energy X-ray absorptiometry (DXA)), resulting in a NNS of 2.1 for women and 3.6 for men. The indication for treatment of osteoporosis increased to an NNS of 1.5 for females and 2.4 for males if the fracture risk assessment tool (FRAX) was included in the diagnostics (DXA and FRAX). With regard to the energy of trauma, the NNS for treatment following DXA and FRAX was 1.5 for LEF and 2.9 for HEF. Subgroup analysis revealed that HEF males within the decennia 50+ and 80+ had an NNS of around 3, i.e., comparable to females and about twice as high as LEF patients.
  
  
  CONCLUSIONS
  These preliminary findings appear to confirm the pragmatic approach to screening in a standardized manner for osteoporosis in all non-vertebral fracture patients aged 50 and older-independently of both gender and level of trauma energy.
authors.affiliation: Department of Rheumatology, Cantonal Hospital, Tellstr.1, CH-5001, Aarau, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hemmeler
authors.affiliation: Department of Traumatology, Cantonal Hospital, Trauma Unit, Tellstr.1, CH-5001, Aarau, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Morell
authors.affiliation: Amsler Consulting, Gundeldingerrain 111, CH-4059, Basel, Switzerland.
authors.forename: Felix
authors.initials: F
authors.lastname: Amsler
authors.affiliation: Department of Traumatology, Cantonal Hospital, Trauma Unit, Tellstr.1, CH-5001, Aarau, Switzerland. thomas.gross@ksa.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gross
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D013557:Switzerland; D014193:Trauma Centers
keywords: Densitometry; Fracture; Fracture risk assessment tool; Gender; Osteoporosis; Trauma energy