Epidemiology of Bone Fracture in Female Trauma Patients Based on Risks of Osteoporosis Assessed using the Osteoporosis Self-Assessment Tool for Asians Score

Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao‐Jen; Chen, Yi‐Chun; Chien, Peng‐Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

doi:10.3390/ijerph14111380

Cited by 7 publications

(5 citation statements)

References 50 publications

(62 reference statements)

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“…Femoral shaft and distal fractures can occur in younger patients without any evidence of osteoporosis, usually as a result of a high-energy trauma such as a motor vehicle accident or motorcycle accident [8, 9, 30, 31]. The impact of the energy transmitted to the bone is generally greater in traffic accidents than in fall accidents, and the point of impact to the femur is not limited to the greater trochanter, which commonly occurs in falls.…”

Section: Discussionmentioning

confidence: 99%

The influence of ageing on the incidence and site of trauma femoral fractures: a cross-sectional analysis

Rau

Kuo

et al. 2019

BMC Musculoskelet Disord

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Background: This study aimed to determine the influence of ageing on the incidence and site of femoral fractures in trauma patients, by taking the sex, body weight, and trauma mechanisms into account. Methods: This retrospective study reviewed data from adult trauma patients aged ≥20 years who were admitted into a Level I trauma center, between January 1, 2009 and December 31, 2016. According to the femoral fracture locations, 3859 adult patients with 4011 fracture sites were grouped into five subgroups: proximal type A (n = 1359), proximal type B (n = 1487), proximal type C (n = 59), femoral shaft (n = 640), and distal femur (n = 466) groups. A multivariate logistic regression analysis was applied to identify independent effects of the univariate predictive variables on the occurrence of fracture at a specific site. A two-dimensional plot was presented visually with age and the propensity score accounts for the risk of a fracture at a specific femoral site. Results: This analysis revealed that older age was an independent variable that could positively predict the occurrence of proximal type A (OR [95%CI]: 1.03 [1.03-1.04], p < 0.001) and B fractures (1.02 [1.01-1.02], p < 0.001), and negatively predict the occurrence of proximal type C (0.96 [0.94-0.98], p < 0.001), shaft (0.95 [0.95-0.96], p < 0.001), and distal fractures (0.98 [0.98-0.99], p < 0.001). Discussion: Using the propensity scores which account for the risk of a fracture in a specific femoral site, this study revealed that the older patients were at a higher risk of developing proximal type A and type B fractures, while a lower risk of developing fractures in the shaft and distal femur. This incidence of fracture site can largely be explained by agerelated factors, including a decrease in bone strength and falling being the most common mechanism of trauma in older patients. Conclusions: This study revealed a difference in the involvement of age in the incidence of femoral fracture sites in the trauma patients.

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Section: Discussionmentioning

confidence: 99%

The influence of ageing on the incidence and site of trauma femoral fractures: a cross-sectional analysis

Rau

Kuo

et al. 2019

BMC Musculoskelet Disord

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“…Elderly individuals are at the greatest risk of a fall accidents [1,2] and their consequences, such as fractures, immobility, and sometimes even death [3][4][5][6][7]. In addition to pain, a femoral fracture results in a curtailment of physical activity, increased dependence, and rapid worsening of the health status.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Huang

et al. 2020

IJERPH

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Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI < 82; group 1, n = 127), moderate-risk group (GNRI 82–92; group 2, n = 179), low-risk group (GNRI 92–98; group 3, n = 123), and no-risk group (GNRI > 98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. Results: The patients in groups 1–3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34–29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.

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“…Conversely, a study reported that patients with a highrisk OSTA score were 8.3 times higher to experience fractures than patients with low OSTA scores. 37 The sensitivity of the OSTA score was 45.83%, which means that as much as 45.83% of patients who obtained positive diagnostic results have obtained fractures, and the specificity of the OSTA score was 50%, so 50% of all healthy patients will have a negative diagnostic test. The PPV of the OSTA score was 57.89%, which means that the probability of patients with a positive test result who truly have fractures was 57.89%, while the NPV was 38.09% which means that the probability of patients with a negative test result who have no fractures was as much as 38.09%.…”

Section: Original Articlementioning

confidence: 98%

Predictive factors and the relationship between the early detection of osteoporosis and pathological fractures in Indonesian menopausal women

Supriyatiningsih¹,

Fredianto²,

Arifuddin³

et al. 2022

Bali Med J.

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Background: Estrogen deficiency in menopausal women induces bone loss and makes them prone to pathological fractures. Age, body mass index (BMI), parental history of osteoporosis, and smoking tobacco also increase bone loss and pathological fractures. This study aims to determine whether age, BMI, parental history of osteoporosis, and smoking tobacco can predict pathological fractures in menopausal women. Moreover, the relationship between the early detection of osteoporosis with pathological fracture incidence will also be determined. Methods: This is an analytic observational epidemiological research with a cross-sectional retrospective design that involved 40 menopausal women. The data were collected from the patients' medical records 2020 in Obstetrics and Gynecology Clinic, Asri Medical Center (AMC) Muhammadiyah Hospital, Yogyakarta. The predictive factors for pathological fracture (age, BMI, parental history, smoking tobacco) were analyzed by using Fisher's exact test and the relationship between osteoporosis early detection, including bone mineral density (BMD) value, parathyroid hormone (PTH) levels, osteocalcin levels, and osteoporosis self-assessment tool for Asians (OSTA) score, with pathological fractures were investigated by using the chi-square test. Result: Age has a significant relationship with the occurrence of pathological fractures in menopausal women (OR = 6.6, 95% CI: 1.128-8.604, p = 0.042), while BMI, parental history of osteoporosis, and smoking tobacco did not have a significant relationship with pathological fractures (p > 0.05). Early detection of BMD and PTH was also found to have a significant relationship to fracture incidence. Additionally, menopausal women with high PTH levels and osteoporosis BMD values are eight times and four times greater risk of acquiring fractures than menopausal women with normal BMD values and PTH levels. Conclusion: Age can be a predictive factor for pathological fractures, and the early detection of PTH and BMD is related to the occurrence of pathological fractures in menopausal women.

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Epidemiology of Bone Fracture in Female Trauma Patients Based on Risks of Osteoporosis Assessed using the Osteoporosis Self-Assessment Tool for Asians Score

Cited by 7 publications

References 50 publications

The influence of ageing on the incidence and site of trauma femoral fractures: a cross-sectional analysis

The influence of ageing on the incidence and site of trauma femoral fractures: a cross-sectional analysis

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Predictive factors and the relationship between the early detection of osteoporosis and pathological fractures in Indonesian menopausal women

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