Incidence of Fractures in Persons over 35 Years of Age: A Report to the M.R.C. Working Party on Fractures in the Elderly

Knowelden, J.; Buhr, A. J.; Dunbar, Olive

doi:10.1136/jech.18.3.130

Cited by 111 publications

(69 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(25,26) In accordance with published data, (25) we found Cortical thickness was measured 5 cm below the major tubercle. that most humerus fractures sustained above the age of 50 years were associated with minimal trauma (60.2%), with the incidence being higher in women than in men, and localization at the proximal humerus accounting for some 85% of the fractures.…”

Section: Discussionsupporting

confidence: 79%

“…Shaft fractures accounted for 10% of low-energy humeral fractures, and occurred more frequently in women than in men. In keeping with published data, (18,25) there was a slightly increased frequency of these fractures with age in the female population: 10 of 100 patients in patients aged 50 to 65 years, and 12.8 of 100 patients in patients aged !80 years. Ct.Th of the humerus was similar in patients with shaft fractures compared to patients with proximal fractures, and there was no difference in the use of either bisphosphonates or glucocorticoids between the two groups of patients.…”

Section: Discussionsupporting

confidence: 74%

See 1 more Smart Citation

Low-energy fractures of the humeral shaft and bisphosphonate use

Yavropoulou

Giusti

Ramautar

et al. 2012

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Atypical fractures of the femur have been reported to occur in patients on long-term treatment with bisphosphonates; however, causality has not been proven, and it is not known whether similar fractures may occur in other long bones. We addressed this issue by examining the relationship between humeral shaft fractures and bisphosphonate use. We identified all patients aged !50 years consecutively admitted to a single center with a new fracture of the humerus. All individual radiographs were examined and fracture site was classified. A case-control study was undertaken in patients with humeral shaft fractures, and controls were sex-and age-matched patients with proximal humeral fractures in a 1:4 ratio. Patients with shaft fractures and radiographic characteristics similar to those of atypical femoral fractures were compared with those with ordinary shaft fractures. The association between ''atypical'' fractures and bisphosphonate or glucocorticoid use was examined. A total of 198 patients had a low-energy fracture of the humerus; 20 of these patients had a shaft fracture (10%). These 20 patients (cases) were matched with 80 patients with proximal fractures (controls). Bisphosphonates were used by 5% of cases and by 6.3% of controls (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.09-6.85); glucocorticoids were used by 10% of cases and 8.8% of controls (OR, 1.15; 95% CI, 0.23-5.83). There was no difference in cortical thickness between cases and controls and bisphosphonate or glucocorticoid users and nonusers. Four of the 20 patients with shaft fractures had ''atypical'' radiographic features, with significantly increased cortical thickness, but none of these had ever been treated with bisphosphonates or glucocorticoids. Our results show that low-energy fractures of the humeral shaft with ''atypical'' radiographic characteristics are infrequent and are not associated with the use of bisphosphonates or glucocorticoids. ß

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 74%

Low-energy fractures of the humeral shaft and bisphosphonate use

Yavropoulou

Giusti

Ramautar

et al. 2012

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

show abstract

“…(83) The age-specific incidence rates (per 100,000) for subtrochanteric fractures increased between the 65-and 85-year categories in both males and females in Iran, (84) in the United States, (85) and in the United Kingdom. (86) Although femoral shaft fractures were more common among males than among females up to age 49, this gender difference was reversed in the 60-to 69-year age group. (82) Thus subtrochanteric fractures share features of typical osteoporosis-related fractures, including (1) higher incidence among women than among men, (2) a steep increase in incidence with age, and (3) more common occurrence in the elderly after low-energy trauma.…”

Section: Epidemiology Of Subtrochanteric and Femoral Shaft Fracturesmentioning

confidence: 98%

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

999

679

View full text Add to dashboard Cite

Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem. Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures. Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs. Research directions should include development of animal models, increased surveillance, and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management. ß

show abstract

“…To date, rather few epidemiological studies have been undertaken to examine the incidence of this injury (Knowelden et al 1964, Bengner et al 1990, Donaldson et al 1990, Court-Brown and McBirnie 1995, Emami et al 1996, Singer et al 1998, van Staa et al 2001, and with varying results. Most of the earlier epidemiological studies were retrospective or case series from single hospitals, and prior to the present study no analyses on a nationwide basis had been undertaken.…”

mentioning

confidence: 99%

Decreasing incidence of tibial shaft fractures between 1998 and 2004: Information based on 10,627 Swedish inpatients

Weiss¹,

et al. 2008

View full text Add to dashboard Cite

Background and purpose There is a lack of national epidemiological data on the characteristics of patients with tibial shaft fractures. We therefore analyzed data on Swedish patients with tibial shaft fractures in this nationwide population study based on data from 1998 through 2004.Methods Data on all patients with tibial shaft fractures were extracted from the Swedish National Hospital Discharge Register.Results We identified 10,627 hospital admissions for tibial shaft fractures, corresponding to an annual incidence rate of 17 per 100,000 person-years (pyr). The number of hospital admissions decreased by 12% during the period 1998-2004, mostly from a reduction in male incidence. The median (SD) age at admission was 28 (22) years for men and 51 (26) years for women. The two major mechanisms of injury were falls on the same level (48%) and transport accidents (21%). Surgical procedures were dominated by osteosynthesis with nail (48%), followed by closed reduction and plaster cast (27%), and external fixation (12%). 12% of all tibial shaft fractures were classified as open, corresponding to an incidence rate of 2.3 per 100,000 pyr, which declined during 1998-2004.Interpretation This nationwide study of tibial shaft fractures shows a falling off of fracture incidence, a finding that can be used to advantage by healthcare providers.

show abstract

Incidence of Fractures in Persons over 35 Years of Age: A Report to the M.R.C. Working Party on Fractures in the Elderly

Cited by 111 publications

References 1 publication

Low-energy fractures of the humeral shaft and bisphosphonate use

Low-energy fractures of the humeral shaft and bisphosphonate use

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Decreasing incidence of tibial shaft fractures between 1998 and 2004: Information based on 10,627 Swedish inpatients

Contact Info

Product

Resources

About