The association between osteoporotic hip fractures and actinic lesions as a biomarker for cumulative sun exposure in older people—a retrospective case–control study in Argentina

Abstract

The aim of this study was to analyze the association between the presence of actinic lesions (solar keratosis and non-melanoma skin cancer) and osteoporotic hip fractures in older patients. Both pathologies are common conditions in this age group. Since cumulative sun exposure is difficult to quantify, the presence of actinic lesions can be used to indirectly analyze the association between ultraviolet radiation and osteoporotic hip fractures. This was an observational case-control study. We reviewed the centralized medical records of patients with hip fracture (cases, n = 51) and patients with other diseases hospitalized in the same institution and period (controls, n = 59). The mean age of the patients was 80 ± 8.3 years (range 50-103 years). Differences in maternal hip fracture history were found between cases and controls (14.8 and 8 %, respectively; p = 0.047). Falls history in the past year was higher in cases than in controls (p < 0.0001). Actinic lesions were observed in 32.7 % of patients (prevalence rate 23.5 % in cases, 40.7 % in controls; p = 0.04). When considering patients with actinic lesions, controls have a higher FRAX score compared with cases. Although sun exposure is recommended for bone health, it represents a risk factor for actinic lesions. The presence of actinic lesions may indicate a lower osteoporotic hip fracture risk. A balance between adequate lifetime sun exposure and protection against its adverse effects is required for each patient, in the context of geographic location.

Association between Daily Sunlight Exposure and Fractures in Older Korean Adults with Osteoporosis: A Nationwide Population-Based Cross-Sectional Study

“… 29 Of these, the greatest problem is hip fracture, which accounts for more than 20% of all orthopedic patients, 30 and the morbidity, mortality and economic costs of hip fractures are high, particularly in older individuals. 31 Research has shown that hip fracture is one of the most serious osteoporotic complications, 4 and one study showed that female aged 65 years or older who had their first hip fracture event were four times more likely to undergo subsequent episodes, compared to the general population. 32 Therefore, prevention of femoral fracture among fractures is important, which can be expected with greater sunlight exposure.…”

“…Fourth, UV exposure and sunlight absorption can differ significantly depending on geographic location, time of season and day, race, occupation, outdoor activity, lifestyle factors, and sunscreen usage. 4 In our study, we were unable to collect detailed information on the variables related to sun exposure because structured cross-sectional KNHANES data were used. Therefore, research should be conducted to minimize the effect of various ambient UV exposure levels.…”

“… 2 Therefore, risk factor identification to reduce fracture incidence is essential for the implementation of preventive measures. 4 …”

“… 8 Studies have suggested that UV radiation is one of the few environmental exposures that can protect against hip fracture. 4 Sun exposure is recommended for bone health; however, to the best our knowledge, the quantification of sunlight exposure time has not been investigated in patients with osteoporosis. Therefore, in this study, we aimed to investigate the association between daily sunlight exposure duration and fracture in older Korean adults with osteoporosis using data from the Korea National Health and Nutrition Examination Survey (KNHANES).…”

Osteoporosis in Skin Diseases

“…The association between skin cancers, in particular MM, and OP is controversial; some studies claim that certain cancer types have been associated with an increased risk of fractures. However, melanoma and non-melanoma skin cancer were not associated with an increased risk of fractures, but rather a decrease because of major sun exposure and thus, potentially, a high average serum vitamin D level [99][100][101][102]. In contrast, others support the finding that VDR gene polymorphisms influence the risk of melanoma and that FokI F allele is associated with an increased risk of melanoma as well as the finding that Caucasian osteoporotic women with VDR FokI Ff genotype had lower femoral neck BMD than that in women with the VDR FokI FF genotype.…”