Risk assessment for osteoporotic fractures
INTRODUCTION
Osteoporosis is a common disease characterized by low bone mass, microarchitectural disruption, and skeletal fragility, which increases the risk of fracture, especially at the spine, hip, wrist, humerus, and pelvis . Osteoporotic fractures (fragility fractures, low-trauma fractures) occur as a result of a fall from a standing height or less, without major trauma, such as a car accident. In 2000, there were an estimated nine million osteoporotic fractures worldwide, with 1.6 million hip fractures, 1.7 million forearm fractures, and 1.4 million clinical vertebral fractures . Hip and spine fractures are associated with a 10% to 20% increase in mortality. Fractures can cause ambulation problems, depression, loss of independence, and chronic pain.
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Bone mineral density (BMD), bone geometry (size and shape of bone), degree of mineralization, microarchitecture, and bone turnover are all factors that contribute to bone strength . Many patients have access to BMD measurements, and fracture risk has been shown to increase with decreasing BMD . Methodologies such as high-resolution peripheral quantitative computed tomography (HR-pQCT), high-resolution magnetic resonance imaging (HR-MRI) or microMRI, or double tetracycline-labeled transiliac bone biopsy with histomorphometry, which are not routinely used in clinical practice, are required for assessing bone microarchitecture.
Age, previous fracture, falls, glucocorticoid therapy, family history of hip fracture, and current smoking are all non-BMD factors that contribute to fracture risk . Incorporating risk factors other than BMD improves the sensitivity of fracture risk assessment and thus treatment intervention strategies . According to univariate and multivariate analyses, age, prior fracture history, and BMD are the best predictors of fracture risk .
