EN PL
ORIGINAL PAPER
Utility of fragility fracture prediction tools in a group of postmenopausal women
 
More details
Hide details
1
Rehabilitation Clinic, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
 
2
Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
 
3
Healthy Statistic, Krakow, Poland
 
 
Submission date: 2021-04-19
 
 
Final revision date: 2021-07-06
 
 
Acceptance date: 2021-07-16
 
 
Online publication date: 2021-08-20
 
 
Publication date: 2021-09-02
 
 
Reumatologia 2021;59(4):230-236
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Fractures are a common complication of osteoporosis. The main aim of our study was to assess the relation between fractures identified as low energy fractures (fragility), bone mineral density (BMD), trabecular bone score (TBS), and handgrip in a group of postmenopausal women. An additional aim was to determine the relation between fragility fractures and age, height loss, and falls (reported in the last 12 months and 5 years).

Material and methods:
The study was conducted in a group of 120 (mean age 69 years; 59–81, SD 5.3) postmenopausal patients who were referred to the Medical Centre for an osteoporosis screening appointment by their general practitioner. All patients were interviewed (with a questionnaire containing questions on fracture risk factors and highest height), had their anthropometric measures taken (current height and weight) as well as TBS analysis following their DXA (dual-energy X-ray absorptiometry) scan and handgrip measure.

Results:
Sixty patients from the study group had a history of fractures (with a total of 92 fractures), of whom 39 women (76 fractures) were identified as those with a low-energy fracture. Fragility fractures were more likely to be reported in older patients (Me 71 vs. 68 years, p < 0.05). Differences observed between TBS, handgrip and BMD in reference to fragility fractures were not statistically significant. Analysis showed significant correlations between BMD (neck and L1–L4) and TBS fracture risk categories. Falls reported in the last 5 years and height loss were factors which correlated with fragility fractures (p < 0.05).

Conclusions:
Risk of fragility fractures increases with age. Bone mineral density is insufficient as a fracture risk assessment tool. Information on falls and height loss may provide additional data on fracture risk assessment.

 
REFERENCES (40)
1.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006; 17: 1726–1733, DOI: 10.1007/s00198-006-0172-4.
 
2.
Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8: 136, DOI: 10.1007/s11657-013-0136-1.
 
3.
Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporosis Int 2005; 16 (Suppl 2): 3–7, DOI: 10.1007/s00198-004-1702-6.
 
4.
Kanis J, Odean A, Johnell O, et al. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteo­porosis Int 2001; 12: 417–427, DOI: 10.1007/s001980170112.
 
5.
Badurski J (ed.). Osteoartrologia kliniczna. Termedia Wydawnictwo Medyczne, Poznań 2011.
 
6.
Amarowicz J, Czerwiński E, Kumorek A, et al. Vertebral fracture assessment, trabecular bone score and handgrip in a group of postmenopausal women with vertebral fractures – preliminary study. Reumatologia 2018; 56: 80–86, DOI: 10.5114/reum.2018.75518.
 
7.
Kamimura M, Nakamura Y, Sugino N, et al. Associations of self-reported height loss and kyphosis with vertebral fractures in Japanese women 60 years and older: a cross-sectional survey. Sci Rep 2016; 6: 29199, DOI: 10.1038/srep29199.
 
8.
Ambrose AF, Cruz L, Paul G. Falls and fractures: a systematic approach to screening and prevention. Maturitas 2015; 82: 85–93, DOI: 10.1016/j.maturitas.2015.06.035.
 
9.
Gawrońska K, Lorkowski J. Falls, aging and public health – a lite­rature review. Ortop Traumatol Rehabil 2020; 22: 397–408, DOI: 10.5604/01.3001.0014.6044.
 
10.
Siris EC, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fracture. Arch Intern Med 2004; 164: 1108–1112, DOI: 10.1001/archinte.164.10.1108.
 
11.
El Miedany Y. FRAX: re-adjust or re-think. Arch Osteoporos 2020; 15: 150, DOI: 10.1007/s11657-020-00827-z.
 
12.
Warzecha M, Czerwiński E, Amarowicz J, Berwecka M. Trabecular bone score (TBS) in clinical practice – rewiev. Ortop Traumatol Rehabil 2018; 20: 347–359, DOI: 10.5604/01.3001.0012.7281.
 
13.
Martineau P, Silva BC, Leslie WD. Utility of trabecular bone score in the evaluation of osteoporosis. Curr Opin Endocrinol Diabetes Obes 2017; 24: 402–410, DOI: 10.1097/MED. 0000000000000365.
 
14.
Wiśniowska-Szurlej A, Ćwirlej-Sozańska A, Wołoszyn N, et al. Association between handgrip strength, mobility, leg strength, flexibility, and postural balance in older adults under long-term care facilities. Biomed Res Int 2019; 23: 1042834, DOI: 10.1155/2019/1042834.
 
15.
Kim SW, Lee HA, Cho EH. Low handgrip strength is associated with low bone mineral density and fragility fractures in postmenopausal healthy Korean women. J Korean Med Sci 2012; 27: 744–747, DOI: 10.3346/jkms.2012.27.7.744.
 
16.
Li YZ, Zhuang HF, Cai SQ, et al. Low grip strength is a strong risk factor of osteoporosis in postmenopausal women. Orthop Surg 2018; 10: 17–22, DOI: 10.1111/os.12360.
 
17.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: Euro­pean consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423, DOI: 10.1093/ageing/afq034.
 
18.
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16–31, DOI: 10.1093/ageing/afy169.
 
19.
McCloskey EV, Odén A, Harvey NC, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res 2016; 31: 940–984, DOI: 10.1002/jbmr.2734.
 
20.
Lewis R, Gómez Álvarez CB, Rayman M, et al. Strategies for optimising musculoskeletal health in the 21st century. BMC Musculoskelet Disord 2019; 20: 164, DOI: 10.1186/s12891-019-2510-7.
 
21.
Wearing J, Konings P, Stokes M, de Bruin ED. Handgrip strength in old and oldest old Swiss adults – a cross-sectional study. BMC Geriatr 2018; 18: 266, DOI: 10.1186/s12877-018-0959-0.
 
22.
Oksuzyan A, Maier H, McGue M, et al. Sex differences in the level and rate of change of physical function and grip strength in the Danish 1905-cohort study. J Aging Health 2010; 22: 589–610, DOI: 10.1177/0898264310366752.
 
23.
Burger H, van Daele PL, Algra D, et al. The association between age and bone mineral density in men and women aged 55 years and over: the Rotterdam Study. Bone Miner 1994; 25: 1–13, DOI: 10.1016/s0169-6009(08)80203-6.
 
24.
Lu YC, Lin YC, Lin YK, et al. Prevalence of osteoporosis and low bone mass in older chinese population based on bone mineral density at multiple skeletal sites. Sci Rep 2016; 6: 25206, DOI: 10.1038/srep25206.
 
25.
Alarkawi D, Bliuc D, Nguyen TV, et al. Contribution of lumbar spine BMD to fracture risk in individuals with t-score discordance. J Bone Miner Res 2016; 31: 274–280, DOI: 10.1002/jbmr.2611.
 
26.
Eccles E, Thompson JD, Roddam H. An evaluation of fracture liaison services in the detection and management of osteoporotic fragility fractures: a narrative review. Radiography (Lond) 2018; 24: 392–395, DOI: 10.1016/j.radi.2018.05.003.
 
27.
Dhiman P, Andersen S, Vestergaard P, et al. Does bone mineral density improve the predictive accuracy of fracture risk assessment? A prospective cohort study in Northern Denmark. BMJ Open 2018; 8: e018898, DOI: 10.1136/bmjopen-2017-018898.
 
28.
Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis 2017; 76: 802–810, DOI: 10.1136/annrheumdis-2016-210289.
 
29.
Kanis JA, Cooper C, Rizzoli R, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30: 3–44, DOI: 10.1007/s00198-018-4704-5.
 
30.
Kanis JA, Harvey NC, McCloskey E, et al. Algorithm for the mana­gement of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int 2020; 31: 1–12, DOI: 10.1007/s00198-019-05176-3.
 
31.
Compston J, Cooper A, Cooper C, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteo­poros 2017; 12: 43, DOI:10.1007/s11657-017-0324-5.
 
32.
Kolta S, Briot K, Fechtenbaum J, et al. TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 2014; 25: 1759–1764, DOI: 10.1007/s00198-014-2685-6.
 
33.
Pouillès JM, Gosset A, Breteau A, et al. TBS in early postmenopausal women with severe vertebral osteoporosis. Bone 2021; 142: 115698, DOI: 10.1016/j.bone.2020.115698.
 
34.
Lino VT, Rodrigues NC, O’Dwyer G, et al. Handgrip strength and factors associated in poor elderly assisted at a primary care unit in Rio de Janeiro, Brazil. PLoS One 2016; 11: e0166373. DOI: 10.1371/journal.pone.0166373.
 
35.
Kuh D, Hardy R, Blodgett JM, Cooper R. Developmental factors associated with decline in grip strength from midlife to old age: a British birth cohort study. BMJ Open 2019; 9: e025755, DOI: 10.1136/bmjopen-2018-025755.
 
36.
McGrath RP, Kraemer WJ, Snih SA, Peterson MD. Handgrip strength and health in aging adults. Sports Med 2018; 48: 1993–2000, DOI: 10.1007/s40279-018-0952-y.
 
37.
Catalano A, Sardella A, Bellone F, et al. Executive functions predict fracture risk in postmenopausal women assessed for osteoporosis. Aging Clin Exp Res 2020; 32: 2251–2257, DOI: 10.1007/s40520-019-01426-w.
 
38.
Henriquez S, Dunogué B, Porcher R, et al. Handgrip strength is a comorbidity marker in systemic necrotizing vasculitides and predicts the risk of fracture and serious adverse events. Rheumatology (Oxford) 2020; 59: 2581–2590, DOI: 10.1093/rheumatology/kez680.
 
39.
Harvey NC, Odén A, Orwoll E, et al. Falls predict fractures independently of FRAX probability: a meta-analysis of the osteoporotic fractures in men (MrOS) Study. J Bone Miner Res 2018; 33: 510–516, DOI: 10.1002/jbmr.3331.
 
40.
Hillier TA, Cauley JA, Rizzo JH, et al. WHO absolute fracture risk models (FRAX): do clinical risk factors improve fracture prediction in older women without osteoporosis? J Bone Miner Res 2011; 26: 1774–1782, DOI: 10.1002/jbmr.372.
 
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
eISSN:2084-9834
ISSN:0034-6233
Journals System - logo
Scroll to top