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Long-term study highlights prolonged impact of fragility fractures

By Nicole MacKee
Older people may experience mobility and self-care problems for a prolonged period after a fragility fracture, say Canadian researchers.

The researchers analysed 10-year prospective data on 7753 people enrolled in the Canadian Multicentre Osteoporosis Study and found that hip and spine fractures were associated with significant negative impacts on mobility, self-care, ambulation and, among men, pain.

Writing in the Journal of Bone and Mineral Research, the researchers reported that single and multiple hip fractures, as well as multiple spine and rib fractures strongly impacted the health-related quality of life of people aged 50 years and older for a prolonged period of time. Also, they found, women with hip fractures did not regain their prefracture health-related quality of life, and women with spine fractures took five years to regain their prefracture health.

Professor Jacqueline Close, Clinical Director of the Falls, Balance and Injury Research Centre at Neuroscience Research Australia, said fragility fractures were known to be associated with long-term disability and pain, but the strength of this study was its 10-year duration. She noted that although mortality was not reported in this study, up to 25% of people who sustained a hip fracture died within a year.

Professor Close said the significance of vertebral fractures was often overlooked but this study highlighted the prolonged impact these fractures could have on quality of life.

‘Previous studies have shown that vertebral fractures are under-reported and undertreated despite having strong evidence to support pharmacological intervention in fracture risk reduction,’ she told Endocrinology Today.

Professor Close said a two-pronged approach to prevention – preventing falls and maintaining bone health – was needed.

‘There is strong evidence to support balance and strength training exercise to prevent falls. We know that sleeping tablets, antidepressants and antipsychotic agents can significantly increase the chances of fall. An intervention as simple as not wearing multifocal or bifocal glasses in active community dwellers can prevent falls,’ she said.

Increased public awareness of fracture prevention in Australia was also important, she said. ‘A fracture should be considered on the same level as a stroke – [with a risk of] death, disability and loss of independence – yet many middle-aged and older people don’t see fracture prevention as important or relevant to them.’

Professor Close also recommended that GPs consider a fall or low bone mineral density as a warning sign for a fracture in a manner comparable to identifying high blood pressure as a risk factor for stroke.
J Bone Miner Res 2019: e3666. doi: 10.1002/jbmr.3666.