Osteoporosis is a major health problem affecting more than 44
million Americans and contributing to an estimated two million bone
fractures per year. Because diminished estrogen can contribute to bone
loss, menopause-age women have traditionally been the focus of
osteoporosis prevention efforts.
Men face a greater risk of mortality following a fracture related to
osteoporosis, a common disease where the bones become weak and brittle,
according to new research presented today at the 2017 Annual Meeting of
the American Academy of Orthopedic Surgeons (AAOS).
‘Men face a greater risk of mortality following a fracture related to osteoporosis.’
"Although women are more likely to sustain an initial,
osteoporosis-related fragility fracture, men have similar rates of
incurring a subsequent fracture and are at greater risk for mortality
after these injuries," said lead study author Alan Zhang, an
orthopedic surgeon and assistant professor at the University of
California, San Francisco.
In this study, researchers reviewed the Medicare Standard Analytic
Files (SAF) database to identify patients, age 65 and older, who had a
diagnosis of osteoporosis and sustained a fragility fracture between
2005 and 2009. Patient records were stratified by sex and the location
of a first fracture. In addition, the incidence of second fragility
fractures was compared between men and women during a three-year
follow-up period, as well one-year mortality rates.
Of the more than one million patients identified with a diagnosis of
osteoporosis in the analysis, 87% were female and 13%
male. Among these patients:
- Women had a five-fold higher risk for an initial
fragility fracture compared to men, and yet the relative risk for a
subsequent fragility fracture within three years of the first fracture
was slightly lower for women compared to men.
- Men who required surgical treatment for an initial
fragility fracture were more likely to suffer a subsequent fragility
fracture within three years. The exception was in men who suffered a
vertebral (spinal) compression fracture (in these instances the risk was
- Men had higher one-year mortality rates for almost all
fracture types studied (18.7% in men versus 13.9% in
women). The only exception was ankle fractures where one-year mortality
rates between men and women were comparable (8.1% for men and 8.4% for women).
"The key findings from this study show that patient sex can affect
the risk for sustaining a fragility fracture related to osteoporosis,"
said Dr. Zhang. "These findings may be used to better counsel patients
after an initial fragility fracture and to improve predictive tools for
monitoring subsequent injuries."
Last year, AAOS joined the American Orthopedic Association, the
Orthopedic Trauma Association (OTA) and the International Geriatric
Fracture Society (IGFS) in drafting and approving new patient guidelines
for preventing fragility fractures. "Orthopedic Care of Patients with
Fragility Fractures" recommends that physicians proactively screen,
monitor, and if necessary, assist in getting treatment for all elderly
and other at-risk patients for osteoporosis following an initial bone
fracture to prevent subsequent fractures.