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BOSTON – Each year, more than 2 million elderly Americans experience a fragility fracture at the hip, spine or wrist. In most cases, fragility fractures result from a fall in standing height or less, underlying bone damage, and not a high shock force. Loss of bone mineral density (BMD) – osteoporosis – is one of the ways that bones can become fragile. Screening for osteoporosis in patients is the current standard for determining the risk of fracture in the elderly. However, low bone mineral density is not the only cause of bone fragility and the majority of elderly people who experience a fragility fracture do not meet the diagnostic criteria for osteoporosis. Doctors currently lack validated means to assess the risk of fracture in these patients.
In the largest prospective study of its kind, researchers at the Beth Israel Deaconess Medical Center (BIDMC) and the Hebrew SeniorLife Aging Research Institute have used a high-resolution tomography to determine whether or not to have a high-resolution scan. other bone characteristics than bone mineral density could be used to determine the fracture. risk. The team found that assessing the microstructure of two different types of bone tissue – compact bone and cancellous bone – can be helpful in predicting the incidence of fragility fractures in those who would otherwise not be identified as being at risk. The study is published today in The Lancet Diabetes and Endocrinology.
"Older women are at particularly high risk of fracture.In fact, the number of women who will experience a fragility fracture in any given year is greater than the number of women who will have a stroke, a breast cancer or myocardial infarction combined "lead author Mary L. Bouxsein, PhD, director of the Center for Advanced Studies in Orthopedics at BIDMC. "Improved methods for identifying patients who have fractures that are common but that standard clinical tests do not identify at high risk would allow us to target treatment on this important group and ultimately reduce the burden of fractures."
The multinational study included more than 7,000 women and men aged from five countries in North America and Europe. Participants – eight research cohorts from the Mayo Clinic, the Framingham study in Massachusetts and French, Canadian, Swiss and Swedish sites in the International Consortium for Bone Microarchitecture – underwent bone scan measurements and legs.
While only 8% of participants met the diagnostic criteria for osteoporosis, 11% of participants suffered a fracture. Those who suffered a fracture were more likely to be older women, having a lower BMI, taking osteoporosis medications and having already suffered a fracture. Fractured participants had worse bone measurements for almost all parameters compared to those who did not fracture.
The analysis of the scientists demonstrated that several measurements of the density and structure of bone at different places in the bone – including the density of compact bone tissue and the thickness of spongy bone tissue at the wrist – were predictive of the fracture. The breaking load, the stress under which the bone begins to fracture, was the hallmark of the bone most strongly associated with fracture risk.
"The results of this large international cohort of women and men suggest deficits in bone density and structure contribute to the risk of fracture regardless of bone mineral density and current assessment tools." of risk, "said Lisa Samelson, PhD, epidemiologist at the Aging Research Institute at Hebrew SeniorLife and at Harvard Medical School, and senior author of the study. "In addition, evaluation of these bone characteristics may be helpful in those who would not otherwise be identified as having a high risk of fracture."
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Other authors include Douglas P. Kiel, co-lead author of the Hebrew SeniorLife Aging Research Institute; Serkalem Demissse of Boston University and Claes Ohlsson of the University of Gothenburg, Sweden. A full list of contributors is available online at http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30308-5/fulltext
This work was supported by the National Institutes of Health (NIH) (National Institute of Musculoskeletal and Skin Diseases of Arthritis [NIAMS]R01AR061445; National Institute of Heart, Lungs and Blood [NHLBI] Framingham Heart Study, Contract No. N01-HC-25195, (HHSN268201500001I). Hebrew SeniorLife's friends and a research grant from the research program initiated by Merck Sharp & Dohme researchers also provided additional support.
About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a subsidiary of Harvard Medical School affiliated for patient care, teaching and research. It regularly ranks as a national leader among independent hospitals receiving funding from the National Institutes of Health.
BIDMC is in the community with Beth Israel Deaconess Hospital – Milton, Beth Israel Deaconess Hospital – Needham, Beth Israel Deaconess Hospital – Plymouth, Anna Jaques Hospital, Cambridge Health Alliance, Lawrence General Hospital, MetroWest Medical Center, Signature Healthcare, Beth Israel Deaconess HealthCare , Community Care Alliance and Atrius Health. BIDMC is also affiliated with the Joslin Diabetes Center and Hebrew SeniorLife and is a research partner of the Dana-Farber / Harvard Cancer Center and Jackson Lab. BIDMC is the official hospital of the Boston Red Sox. For more information, visit http: // www.
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