Age, Bone Mass Predict Fracture Risk

Study of Postmenopausal Women Shows Depression May Also Be a Risk Factor

From the WebMD Archives

Nov. 14, 2006 (Washington, D.C.) -- Age and low bone mass continue to be major predictors of fractures in postmenopausal women, according to a study of more than 170,000 women presented at the annual meeting of the American College of Rheumatology in Washington, D.C.

More than 1.5 million fractures a year result from osteoporosis, a disease that causes bones to thin and become brittle, according to the National Osteoporosis Foundation, based in Washington, D.C.

The new study, dubbed the National Osteoporosis Risk Assessment Study (NORA), confirms that previously identified risk factors -- a history of fracture, low bone mass, advancing age, poor health, and others -- remain the biggest predictors of fracture risk, says a study author, Ethel S. Siris, MD.

Onus on Women

"A wide array of risk factors are important for women and they need to talk to their doctor about receiving a bone mineral density test and what else they should be doing to minimize their risk of fracture," says Siris, the Madeline C. Stabile Professor of Clinical Medicine and the director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York City.

"This kind of information will help women open a conversation with their doctors about their personal risk factors for fractures," Siris tells WebMD.

"Patients have to be proactive," she tells WebMD. "We know in the U.S. that osteoporosis is a major public health issue in older women, but there is a gap between what we should be doing and what we are doing."

While prescription medications play a role in reducing fracture risk, adequate calcium and vitamin D consumption, as well as strategies to protect against falls, are also important, Siris says.

Risk Factors

Of the 170,314 women who completed surveys at one, two, and five years, 7,989 reported a fracture.

The study included postmenopausal women 50 or older who had no previous diagnosis of osteoporosis and were not taking medication for the disease.

In the study, women over 65 were more likely to sustain a fracture than 50- to 64-year-olds; those 85 and up were even more likely.


There was a 12% increased risk for 65- to 69-year-olds and a double risk for those 85 and up, when compared with the 50- to 64-year-olds.

History of fracture, low bone mass (as in osteoporosis), and poor to fair self-rated health topped the list of risk factors.

Women who reported they were in poor/fair health had a 71% increased risk compared with women who claimed to be in excellent health.

In addition, black and Asian women had a lower risk for fracture than white women.

Asian women typically have greater risk of fracture, but Siris speculates these women experienced "silent" spine fractures, and as a result did not report them.

Self-reported loss of height was a risk factor for fractures as well, the study showed.

Women with symptoms of depression also showed an increased risk for fracture compared with non-depressed women, according to the new data.

"People with depression probably have a variety of physical problems," Siris speculates. "They may not eat well or sleep well, which could affect their overall health and fracture risk, but we don't know for sure how depression relates to fracture risk."

New Targets for Prevention

"This is a big study with lots of patients that can give us guidance," says Eric Ruderman, MD, an associate professor of medicine at the Northwestern University Feinberg School of Medicine, in Chicago.

"Ultimately, osteoporosis is not the problem -- fractures are the problem. And to the extent that this gives us other targets for fracture prevention, it's helpful," Ruderman tells WebMD.

"It's a wake-up call," he says. "We need to make sure women are getting their calcium and vitamin D [and] doing weight-bearing exercises."

The bottom line is that "we need to make sure that if there are risk factors that can be modified, they are being modified," says Ruderman.

WebMD Health News Reviewed by Louise Chang, MD on November 14, 2006


SOURCES: 70th annual meeting of the American College of Rheumatology, Washington, D.C., Nov. 10-15, 2006. Ethel S. Siris, MD, Madeline C. Stabile Professor of Clinical Medicine; director, Toni Stabile Osteoporosis Center, Columbia University Medical Center, New York City. Eric Ruderman, MD, associate professor of medicine, Northwestern University Feinberg School of Medicine, Chicago.

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