Fractures can be deadly. Why is preventive action rare?

Doug Hendrie

10/02/2021 4:03:18 PM

What’s your skeletal age? It may well be much older than your date of birth – especially if you have osteoporosis or a fracture.

Elderly woman with broken arm
Fractures can be very serious for older people – how can they be averted?

It is well established that older people who have a fracture are significantly more likely to die within a year.
A fragility fracture sends the risk of premature death skyrocketing, rising by around 50% in both men and women. Hip fractures are particularly dangerous, with 33% of adults over 50 dying within a year of fracturing their hips.
Fractures are not uncommon – they will happen to half of all women over the age of 50, and one third of men. The lifetime risk of a hip fracture in women (almost 20%) is likely higher than the risk of developing breast cancer (around 14%), and fracturing a bone also doubles your risk of subsequent fractures.
Around 80% of all fractures are in people aged over 50. And yet, only 20% of people with a fragility fracture take osteoporosis treatments to lower their future risk.
Why, asks Professor Tuan Nguyen, is there seeming complacency around this risk?
‘This is something people don’t realise – people with a fracture have a higher risk of death,’ he told newsGP.
Healthy Bones Australia estimates 173,000 bones were broken in Australia last year, with almost 4% of the population living with osteoporosis.
In a bid to increase patient knowledge of their risks, Professor Nguyen and his team at the Genetic Epidemiology of Osteoporosis Lab at the Garvan Institute have released new research which estimates a patient’s skeletal age.
Skeletal age provides an estimate of bone health based on chronological age, bone density and any previous fractures.
For instance, a 70-year-old man with one fracture would have a skeletal age of 75 using this calculator. But if he had a second fracture, he would go to having the same fracture risk as an 87-year-old man with a healthy risk profile.
‘I hope by conveying this information to patients and the community that people may undertake actions to prevent further fractures and mortality,’ Professor Nguyen said.
‘It’s never too early to think about your bone health. Do not wait until a fracture has occurred to take preventive action. If your skeletal age is higher than your actual age, you should seek medical advice from your doctor on how to manage the higher risk.
‘People aged 50 and older can use this calculator and discuss it with their GP. This way I hope we can have more evidence-based and frank discussions about mortality [and fractures]. The problem at the moment is up to 80% of people with a fracture do not receive enough treatment.
‘There are concerns out there that treatments for osteoporosis may lead to more fractures, but that is for a very small proportion.
‘We know that treatment can reduce mortality by up to 28%. And yet people still do not receive treatment.’
Professor Nguyen’s goal is to have patients and GPs turning to the calculator to figure out their levels of risk – and then putting in place protective measures, such as taking preventive medication after a fracture, as well as exercise, ensuring enough dietary calcium and adequate vitamin D.
‘Bone is not a static tissue. It responds to weight-bearing exercise,’ he said.
‘Take astronauts – after two weeks in zero gravity, they can lose up to 10% of their bone. That’s why when they land, we do not allow them to walk – they have to be carried away. So physical activity is very good.’
Lead author of the paper, Dr Thao Ho-Le, noted that the work was designed to build on existing models to predict the risk of a first fracture – such as the Garvan Fracture Risk Calculator
‘It remains unclear why some individuals do well after an initial fracture, while others go on to sustain further fractures and have a higher risk of mortality,’ she said.
‘We set out to develop a model to complement existing tools, which could simultaneously predict an individual’s risk of subsequent fractures and consequently, their chance of premature death.’
The calculator is based on data from the world’s longest running osteoporosis study, which has tracked people in Dubbo, NSW, since 1989, and followed them up to determine their risk.
The team will release a publicly available skeletal age calculator online in coming months.
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