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Two-Thirds of All Fractures Are Not Attributable to Osteoporosis and Advancing Age: Implications for Fracture Prevention


CONTEXT: Although bone mineral density (BMD) is strongly associated with fracture and postfracture mortality, the burden of fractures attributable to low BMD has not been investigated. OBJECTIVES: We sought to estimate the population attributable fraction of fractures and fracture-related mortality that can be attributed to low BMD. DESIGN AND SETTING: This study is a part of an ongoing population-based prospective cohort study, the Dubbo Osteoporosis Epidemiology study. In total, 3700 participants aged >/=50 years participated in the study. Low-trauma fracture was ascertained by X-ray reports, and mortality was ascertained from the Birth, Death and Marriage Registry. RESULTS: Overall, 21% of women and 11% of men had osteoporotic BMD. In univariable analysis, 21% and 16% of total fractures in women and men, respectively, were attributable to osteoporosis. Osteoporosis combined with advancing age (>70 years) accounted for 34% and 35% of fractures in women and men, respectively. However, these two factors accounted for approximately 60% of hip fractures. About 99% and 66% of postfracture mortality in women and men, respectively, were attributable to advancing age, osteoporosis, and fracture; however, most of the attributable proportion was accounted for by advancing age. CONCLUSIONS: A substantial health care burden of fracture is on people aged <70 years or nonosteoporosis, suggesting that treatment of people with osteoporosis is unlikely to reduce a large number of fractures in the general population.

Type Journal
ISBN 1945-7197 (Electronic) 0021-972X (Linking)
Authors Mai, H. T.; Tran, T. S.; Ho-Le, T. P.; Center, J. R.; Eisman, J. A.; Nguyen, T. V.
Responsible Garvan Author Prof John Eisman
Published Date 2019-08-01
Published Volume 104
Published Issue 8
Published Pages 3514-3520
Status Published in-print
DOI 10.1210/jc.2018-02614
URL link to publisher's version