The epidemiology of fragility fractures: Is there a role for bone quality?
- 1 February 1993
- journal article
- research article
- Published by Springer Science and Business Media LLC in Calcified Tissue International
- Vol. 53 (S1), S23-S26
- https://doi.org/10.1007/bf01673397
Abstract
Fragility fractures, particularly those of the hip, vertebrae, and distal forearm, constitute a major public health problem. The two ultimate determinants of fracture are bone strength and propensity to trauma. Bone strength depends not only upon bone mass but also upon a variety of qualitative aspects of bone structure. These include its architecture, the amount of fatigue damage it has sustained, and changes in its bulk material properties, indices that are collectively subsumed into the term “bone quality” Fragility fractures show differences in their patterns of incidence by age, sex, ethnic group, geographic area, and season. Many of these differences are currently unexplained, and disorders of bone quality might contribute to them. There are two fracture sites at which evidence implicates bone quality more directly—the spine and proximal femur. Many vertebral compression fractures follow minimal trauma, and controlled studies suggest that vertebral microarchitecture contributes to fracture risk independently of vertebral bone mass. At the hip, observational studies have pointed to a role for disordered trabecular architecture, accumulation of microfractures (fatigue damage), and the accumulation of osteoid. The extent to which these phenomena act independently of bone mass, however, remains uncertain.Keywords
This publication has 27 references indexed in Scilit:
- Vitamin D3and Calcium to Prevent Hip Fractures in Elderly WomenNew England Journal of Medicine, 1992
- Epidemiology of osteoporosisTrends in Endocrinology & Metabolism, 1992
- Incidence of clinically diagnosed vertebral fractures: A population-based study in rochester, minnesota, 1985-1989Journal of Bone and Mineral Research, 1992
- Incidence of hip fractures in the elderly: A cross-national analysisOsteoporosis International, 1991
- Clinical Use of Bone DensitometryNew England Journal of Medicine, 1991
- Trends in admissions for hip fracture in England and Wales, 1968-85.BMJ, 1990
- Differences in the incidence of hip fracture: Comparison of an urban and a rural population in southern SwedenActa Orthopaedica, 1988
- Evaluation of the singh index and femoral calcar width as epidemiological methods for measuring bone mass in the femoral neckClinical Radiology, 1986
- Relationships between surface, volume, and thickness of iliac trabecular bone in aging and in osteoporosis. Implications for the microanatomic and cellular mechanisms of bone loss.JCI Insight, 1983
- Fifty-Year Trend in Hip Fracture IncidencePublished by Ovid Technologies (Wolters Kluwer Health) ,1982