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Older men who sustain a hip fracture experience greater declines in bone mineral density at the contralateral hip than non-fractured comparators.

ABSTRACT: Men experience declining bone mineral density (BMD) after hip fracture; however, changes attributable to fracture are unknown. This study evaluated the excess BMD decline attributable to hip fracture among older men. Older men with hip fracture experienced accelerated BMD declines and are at an increased risk of secondary fractures. INTRODUCTION:The objective was to determine whether bone mineral density (BMD) changes in men after hip fracture exceed that expected with aging. METHODS:Two cohorts were used: Baltimore Hip Studies 7th cohort (BHS-7) and Baltimore Men's Osteoporosis Study (MOST). BHS-7 recruited older adults (N = 339) hospitalized for hip fracture; assessments occurred within 22 days of admission and at 2, 6, and 12 months follow-up. MOST enrolled age-eligible men (N = 694) from population-based listings; data were collected at a baseline visit and a second visit that occurred between 10 and 31 months later. The combined sample (n = 452) consisted of Caucasian men from BHS-7 (n = 89) and MOST (n = 363) with ? 2 dual-energy X-ray absorptiometry scans and overlapping ranges of age, height, and weight. Mixed-effect models estimated rates of BMD change, and generalized linear models evaluated differences in annual bone loss at the total hip and femoral neck between cohorts. RESULTS:Adjusted changes in total hip and femoral neck BMD were - 4.16% (95% CI, - 4.87 to - 3.46%) and - 4.90% (95% CI, - 5.88 to - 3.92%) in BHS-7 participants; - 1.57% (95% CI, - 2.19 to - 0.96%) and - 0.99% (95% CI, - 1.88 to - 0.10%) in MOST participants; and statistically significant (P < 0.001) between-group differences in change were - 2.59% (95% CI, - 3.26 to - 1.91%) and - 3.91% (95% CI, - 4.83 to - 2.98%), respectively. CONCLUSION:Hip fracture in older men is associated with accelerated BMD declines at the non-fractured hip that are greater than those expected during aging, and pharmacological interventions in this population to prevent secondary fractures may be warranted.

SUBMITTER: Rathbun AM

PROVIDER: S-EPMC5898436 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Older men who sustain a hip fracture experience greater declines in bone mineral density at the contralateral hip than non-fractured comparators.

Rathbun A M AM Magaziner J J Shardell M D MD Yerges-Armstrong L M LM Orwig D D Hicks G E GE Hochberg M C MC

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 20171024 2

Men experience declining bone mineral density (BMD) after hip fracture; however, changes attributable to fracture are unknown. This study evaluated the excess BMD decline attributable to hip fracture among older men. Older men with hip fracture experienced accelerated BMD declines and are at an increased risk of secondary fractures.<h4>Introduction</h4>The objective was to determine whether bone mineral density (BMD) changes in men after hip fracture exceed that expected with aging.<h4>Methods</ ...[more]

PMID: 29063216

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Project description:Fall prevention programs have shown inconclusive results concerning hip fracture reduction. We found that fallers with poor health, low societal participation, and use of psychotropics/painkillers had a threefold to fivefold increased hip fracture risk compared to non-fallers without these risk factors. This may help target fall prevention towards high-risk individuals.IntroductionTo investigate whether self-reported information on health, societal participation, and drug use in older people, easily obtainable by health care providers, contribute to predict future hip fracture beyond self-reported falls.MethodsWe used data from 3801 women and 6439 men aged 70-79 years participating in population-based studies in five counties in Norway 2000-2003. Height and weight were measured. Socioeconomic status, lifestyle, health status, and history of falling were self-reported through questionnaires. Falls last year were dichotomized into one or more versus no falls. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Hazard ratios (HR) with 95% confidence intervals (95% CI) for hip fracture by combinations of risk factors with history of falling were estimated using Cox proportional hazards regression.ResultsMore women (32.4%) than men (27.7%) reported one or more falls during the previous year, and 17.9% of women (n = 682) and 8.9% of men (n = 572) suffered a hip fracture during median 11.6 years of follow-up. Poor health, low societal participation, and use of psychotropics/analgesics among fallers were strong predictors of hip fracture. The presence of all three risk factors and history of falling was associated with HR 2.92 (95% CI 2.10-4.05) for hip fracture in women and HR 4.60 (95% CI 2.71-7.81) in men compared to non-fallers without these factors.ConclusionOur study indicates that self-assessment of health, information about activities outside home, and drug use among fallers far better identify high risk of hip fracture in older people than information about falls alone.

Project description:BackgroundMuscle weakness is a key factor in the increase risk of falls and might also play a significant role in the increase of risk of hip fracture. Computed tomography-measured muscle size and muscle density are well-established imaging biomarkers used in studies of physical function, frailty or cancer, but limited to hip fracture. In particular, it is warranted to have a better understanding of the performance of muscle size and density in the discrimination of acute hip fractures. We also aim to determine age-related differences of muscle size and density in healthy controls and hip fracture patients.MethodsFour hundred thirty-eight low-energy acute hip fracture cases and 316 healthy controls from the China Action on Spine and Hip Status study were included in the study. Muscle cross-sectional area and density were measured for the gluteus maximus and gluteus medius and minimus. Areal bone mineral density (aBMD) of the femoral neck and total hip was measured. Using propensity score matching, we generated three samples with cases and controls matched for age, body mass index, and gender: femoral neck fracture (FNF), intertrochanteric fracture (ITF), and any hip fracture vs. controls, respectively.ResultsHandgrip strength, gluteus muscle area and density, and bone parameters of the matched hip fracture groups were lower than those of the correspondence control groups, respectively (P < 0.05). The univariate analysis showed that associations of aBMD with FNF and with ITF were significantly weaker than associations between fracture and muscle parameters. Gluteus medius and minimus muscle density showed the highest areas under the curve (AUC) with FNF (0.88, 95% confidence interval, 0.85-0.92) and trochanteric fracture (0.95, 95% confidence interval, 0.92-0.97). The model including all muscle and bone parameters provided the highest AUC (FNF: AUC 0.912; ITF: AUC 0.958), and AUC results of another selected model without muscle density showed that association with fracture significantly dropped (FNF: AUC 0.755; ITF: AUC 0.858). Separate results for the two age groups younger and older than 70 years showed no age-related significant differences in discriminate models.ConclusionsMuscle density performs better than aBMD from hip computed tomography X-ray absorptiometry and muscle size in discrimination of hip fracture. Combination of aBMD and muscle density provided the best discrimination. The integration of muscle assessments may trigger a paradigm shift in hip fracture prediction. Gluteus muscle density should also be evaluated as treatment outcome.

Project description:ImportanceScreening for osteoporosis with bone mineral density (BMD) is recommended for older adults. It is unclear whether repeating a BMD screening test improves fracture risk assessment.ObjectivesTo determine whether changes in BMD after 4 years provide additional information on fracture risk beyond baseline BMD and to quantify the change in fracture risk classification after a second BMD measure.Design, setting, and participantsPopulation-based cohort study involving 310 men and 492 women from the Framingham Osteoporosis Study with 2 measures of femoral neck BMD taken from 1987 through 1999.Main outcomes and measuresRisk of hip or major osteoporotic fracture through 2009 or 12 years following the second BMD measure.ResultsMean age was 74.8 years. The mean (SD) BMD change was -0.6% per year (1.8%). Throughout a median follow-up of 9.6 years, 76 participants experienced an incident hip fracture and 113 participants experienced a major osteoporotic fracture. Annual percent BMD change per SD decrease was associated with risk of hip fracture (hazard ratio [HR], 1.43 [95% CI, 1.16 to 1.78]) and major osteoporotic fracture (HR, 1.21 [95% CI, 1.01 to 1.45]) after adjusting for baseline BMD. At 10 years' follow-up, 1 SD decrease in annual percent BMD change compared with the mean BMD change was associated with 3.9 excess hip fractures per 100 persons. In receiver operating characteristic (ROC) curve analyses, the addition of BMD change to a model with baseline BMD did not meaningfully improve performance. The area under the curve (AUC) was 0.71 (95% CI, 0.65 to 0.78) for the baseline BMD model compared with 0.68 (95% CI, 0.62 to 0.75) for the BMD percent change model. Moreover, the addition of BMD change to a model with baseline BMD did not meaningfully improve performance (AUC, 0.72 [95% CI, 0.66 to 0.79]). Using the net reclassification index, a second BMD measure increased the proportion of participants reclassified as high risk of hip fracture by 3.9% (95% CI, -2.2% to 9.9%), whereas it decreased the proportion classified as low risk by -2.2% (95% CI, -4.5% to 0.1%).Conclusions and relevanceIn untreated men and women of mean age 75 years, a second BMD measure after 4 years did not meaningfully improve the prediction of hip or major osteoporotic fracture. Repeating a BMD measure within 4 years to improve fracture risk stratification may not be necessary in adults this age untreated for osteoporosis.

Project description:BackgroundThe impact of gender on functional outcomes after hip fracture is not known. We aimed to determine the extent to which gender influenced functional outcome and response to exercise in older people after hip fracture, and to determine if any differences persisted after adjusting for cognition, weight and age.MethodSecondary analysis of data from the Enhancing Mobility After Hip Fracture trial in which older people after hip fracture received either a lower or higher intensity exercise program. Functional outcomes included physical performance and self-reported measures. Regression models were used to compare genders at baseline, week 4 and week 16, with adjustment for baseline values, cognition, weight and age. Interaction terms were used to assess a differential impact of the intervention by gender.ResultsOutcome data were available for 160 participants, 30 men (19%) and 130 women (81%) at baseline, with the withdrawal of 4 men (13%) and 6 women (5%) at week 16. There were no gender differences for any baseline measures or for most of the 19 functional outcome measures at weeks 4 and 16. At week 4 men performed better in knee extensor strength (2.1 kg, 95% CI 0.6 to 3.7, p < 0.01). This difference did not persist after adjustment for body weight, however persisted after adjusting for baseline, cognition, and age (p = 0.038). At week 4, men performed better in coordinated stability (-10.0 error score, 95% CI -17.6 to -2.4, p=0.010) and this persisted after adjusting for baseline values only but not for cognition and age (p = 0.073). At week 16, men performed better in coordinated stability (-10.2 error score, 95% CI -18.4 to -1.9, p=0.016) and this persisted after adjusting only for cognitive impairment (p = 0.029) but not for age and baseline (p = 0.135). There was no indication of a differential impact of intervention type on the basis of gender.ConclusionsA few between gender differences were observed in strength and balance, however these appeared to be confounded by body weight, age and/or cognition.

Dataset Information

Older men who sustain a hip fracture experience greater declines in bone mineral density at the contralateral hip than non-fractured comparators.

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Older men who sustain a hip fracture experience greater declines in bone mineral density at the contralateral hip than non-fractured comparators.

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