Bone fractures often result from trauma or underlying conditions. Understanding patient-specific risk factors for bone fracture can help to effectively prevent and manage fractures. Bone not only protects our organs and helps facilitate movement, but it is also constantly being built and resorbed (Barnes, et al., 2022). Unfortunately, fractures and the complications from fractures can lead to increased hospitalizations and mortality (LeBoff, et al., 2022).
Bone mass increases through youth and peaks between the ages of 20 and 30 before slowly declining over the rest of an individual’s life span (Barnes, et al., 2022). Osteoporosis is a major cause of bone fracture. It is a disease where one has low bone mineral density and subsequent compromised bone strength. While it affects many different people, osteoporosis is more common in women (LeBoff, et al., 2022). A patient with osteoporosis should be considered high risk for bone fracture.
Advancing age is a significant determinant of bone health. Fracture risk increases as individuals grow older (Barnes, et al., 2022). Reduced bone mineral density, coupled with age-related muscle weakness, predisposes older individuals to fractures even in cases of minor trauma.
Hormonal variations also affect a patient’s risk for bone fracture. Estrogen deficiency, commonly seen in postmenopausal women, but also seen in other medical conditions, leads to accelerated bone loss (Barnes, et al., 2022). In men, low levels of testosterone have been linked to decreased bone mineral density (Barnes, et al., 2022). Thyroid hormones are also important in bone maintenance (Williams & Bassett, 2018).
Specific medical conditions may contribute to elevated risk. Osteoporosis, previously mentioned, is not the only condition that increases patient risk for bone fracture. Rheumatoid arthritis leads to local and generalized bone loss, elevating fracture risk (Raterman, et al., 2020). Hypothyroidism can lead to decreased bone turnover and bone resorption, and hyperthyroidism can cause increased bone turnover and resorption (Williams & Bassett, 2018). Thyrotoxicosis, also known as ‘thyroid storm’ in adults, is also known to lead to osteoporosis and fracture (Williams & Bassett, 2018).
Certain medications may compromise bone health and lead to an elevated risk of fractures. For example, long-term use of glucocorticoids, commonly prescribed for conditions such as rheumatoid arthritis, has been linked to decreased bone density and fracture risk (Ngyuen, et al., 2018). Other drugs including antileptics, GnRH antagonists, loop diuretics, can lead to skeletal problems and increased fracture risk (Ngyuen, et al., 2018).
Nutritional factors significantly influence bone health. Deficiencies in calcium and vitamin D are major contributors to weak or fragile bones. Vitamin D, calcium, and potassium have direct roles in bone reabsorption and formation (Barnes, et al., 2022). Other lifestyle factors that may help a patient decrease the risk of a bone fracture include maintaining a physically active lifestyle and strength training. This promotes bone growth as well as maintenance of bone during adulthood (Barnes, et al., 2022). Modifiable lifestyle factors that can increase the risk of fractures or osteoporosis include excessive smoking and excessive alcohol consumption (Barnes, et al., 2022).
Ultimately, bone mass and fragility fractures are influenced by a variety of factors including nutrition, activity level, age, hormones, and lifestyle. There is a large and alarming treatment gap in osteoporosis that puts many patients at risk for fragility fractures. More efforts should be taken to detect and treat risk factors for fractures in a proactive manner (LeBoff, et al., 2022).
References
Wilson-Barnes, Saskia L et al. “Modifiable risk factors for bone health & fragility fractures.” Best practice & research. Clinical rheumatology vol. 36,3 (2022): 101758. doi:10.1016/j.berh.2022.101758w
LeBoff, M S et al. “The clinician’s guide to prevention and treatment of osteoporosis.” Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA vol. 33,10 (2022): 2049-2102. doi:10.1007/s00198-021-05900-y
Williams, G R, and J H D Bassett. “Thyroid diseases and bone health.” Journal of endocrinological investigation vol. 41,1 (2018): 99-109. doi:10.1007/s40618-017-0753-4
Raterman, Hennie G et al. “Osteoporosis in patients with rheumatoid arthritis: an update in epidemiology, pathogenesis, and fracture prevention.” Expert opinion on pharmacotherapy vol. 21,14 (2020): 1725-1737. doi:10.1080/14656566.2020.1787381
Nguyen, Khac-Dung et al. “Drug-induced bone loss: a major safety concern in Europe.” Expert opinion on drug safety vol. 17,10 (2018): 1005-1014. doi:10.1080/14740338.2018.1524868