Review of Osteoporotic Fractures: Occurrence, Prevention, and Consequences

Abstract

Osteoporosis is a metabolic condition that compromises bone density and architecture, increasing the risk of fractures and impacting morbidity and mortality. The diagnosis involves bone densitometry, in which mineral density in areas prone to fractures is assessed. Primary osteoporosis is age-related and may remain asymptomatic for years, while secondary osteoporosis results from comorbidities or medications. Approximately 80% of postmenopausal Caucasian women have osteoporosis, with an expected increase with aging. Orthopedic treatments are common for fractures, which are often caused by falls in the elderly. Fracture prevention requires public health policies and therapies focused on this goal.

Resumo

A osteoporose é uma condição metabólica que compromete a densidade e a arquitetura ósseas, o que aumenta o risco de fraturas e tem impacto na morbimortalidade. O diagnóstico envolve a densitometria óssea, em que se avalia a densidade mineral em áreas propensas a fraturas. A osteoporose primária, relacionada à idade, pode permanecer assintomática por anos, ao passo que a secundária resulta de comorbidades ou medicamentos. Cerca de 80% das mulheres brancas na pós-menopausa têm osteoporose, com expectativa de aumento com o envelhecimento. Tratamentos ortopédicos são comuns para fraturas, que são frequentemente causadas por quedas em idosos. A prevenção de fraturas é crucial, e requer políticas de saúde pública e terapias com este objetivo.

Keywords

diagnosis - fractures, stress - osteoporosis - risk assessment - treatment

Palavras-chave

avaliação de risco - diagnóstico - fraturas por estresse - osteoporose - tratamento

Financial Support

The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.

Publikationsverlauf

Eingereicht: 19. Dezember 2023

Angenommen: 21. Mai 2024

Artikel online veröffentlicht:
14. Juni 2025

• References

• 1 Kanis JA. on behalf of the World Health Organization Scientific Group (WHO). Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK; 2007. . Available from: https://www.iofbonehealth.org/sites/default/files/WHO_Technical_Report-2007.pdf
• 2 World Health Organization (WHO). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group [‎‎‎‎meeting held in Rome from 22 to 25 June 1992]; 1994‎‎‎‎. Available from: https://apps.who.int/iris/handle/10665/39142
• 3 Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997; 7 (05) 407-413
• 4 Liu J, Guo H, Rai P, Pinto L, Barron R. Medication persistence and risk of fracture among female Medicare beneficiaries diagnosed with osteoporosis. Osteoporos Int 2018; 29 (11) 2409-2417
• 5 De Laet C, Odén A, Johansson H, Johnell O, Jönsson B, Kanis JA. The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporos Int 2005; 16 (03) 313-318
• 6 Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001; 12 (12) 989-995
• 7 Kanis JA, Johansson H, Oden A. et al. A family history of fracture and fracture risk: a meta-analysis. Bone 2004; 35 (05) 1029-1037
• 8 Kanis JA, Johansson H, Oden A. et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 2004; 19 (06) 893-899
• 9 Meikle MC. Control mechanisms in bone resorption: 240 years after John Hunter. Ann R Coll Surg Engl 1997; 79 (01) 20-27
• 10 Lobstein JF. Lehrbuch der Pathologischen Anatomie. Die Specielle Pathologische Anatomie Enthaltend. Stuttgart: Thieme; 1835
• 11 Wilks S. Review and notices. BMJ 1864; 2: 602-605
• 12 Partridge R. Reports of societies. BMJ 1865; 1: 330-332
• 13 Kyes P, Potter TS. Physiological marrow ossification in female pigeons. Anat Rec 1934; 60: 377-379
• 14 Albright F, Smith P, Richardson A. Postmenopausal osteoporosis, its clinical features. JAMA 1941; 116 (22) 2465-2474
• 15 Albright F, Bloomberg E, Smith P. Postmenopausal osteoporosis. Trans Assoc Am Physicians 1940; 55: 298-305
• 16 Cooke AM. Osteoporosis. Lancet 1955; 268 (6870) 877-882
• 17 Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 2006; 194 (2, Suppl) S3-S11
• 18 Lau YT, Ahmed NN. Fracture risk and bone mineral density reduction associated with proton pump inhibitors. Pharmacotherapy 2012; 32 (01) 67-79
• 19 Eastell R, Szulc P. Use of bone turnover markers in postmenopausal osteoporosis. Lancet Diabetes Endocrinol 2017; 5 (11) 908-923
• 20 Winsloe C, Earl S, Dennison EM, Cooper C, Harvey NC. Early life factors in the pathogenesis of osteoporosis. Curr Osteoporos Rep 2009; 7 (04) 140-144
• 21 Melton III LJ, Khosla S, Atkinson EJ, O'Fallon WM, Riggs BL. Relationship of bone turnover to bone density and fractures. J Bone Miner Res 1997; 12 (07) 1083-1091
• 22 Feik SA, Thomas CD, Clement JG. Age-related changes in cortical porosity of the midshaft of the human femur. J Anat 1997; 191 (Pt 3): 407-416
• 23 Sandhu SK, Hampson G. The pathogenesis, diagnosis, investigation and management of osteoporosis. J Clin Pathol 2011; 64 (12) 1042-1050
• 24 Hodgson SF, Watts NB, Bilezikian JP. et al; AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003; 9 (06) 544-564 [published correction appears in Endocr Pract 2004;10(1):90] [published correction appears in Endocr Pract. multiple author names added]
• 25 Kelman A, Lane NE. The management of secondary osteoporosis. Best Pract Res Clin Rheumatol 2005; 19 (06) 1021-1037
• 26 Adams JS, Song CF, Kantorovich V. Rapid recovery of bone mass in hypercalciuric, osteoporotic men treated with hydrochlorothiazide. Ann Intern Med 1999; 130 (08) 658-660
• 27 Sotorník I. [Osteoporosis - epidemiology and pathogenesis]. Vnitr Lek 2016; 62 (Suppl. 06) 84-87
• 28 Paschalis EP, Gamsjaeger S, Hassler N. et al. Vitamin D and calcium supplementation for three years in postmenopausal osteoporosis significantly alters bone mineral and organic matrix quality. Bone 2017; 95: 41-46
• 29 Chen AB, Minami K, Raposo JF. et al. Transient modulation of calcium and parathyroid hormone stimulates bone formation. Endocrine 2016; 54 (01) 232-240
• 30 Ströhle A. [The updated recommendations of the US Institute of Medicine (IOM) on the intake of vitamin D. A critical appraisal]. Med Monatsschr Pharm 2011; 34 (08) 291-298
• 31 Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Przegl Menopauz 2014; 13 (04) 213-220
• 32 Lorenzo J. The many ways of osteoclast activation. J Clin Invest 2017; 127 (07) 2530-2532
• 33 Zheng Z, Wang L, Pan J. Estradiol and proinflammatory cytokines stimulate ISG20 expression in synovial fibroblasts of patients with osteoarthritis. Intractable Rare Dis Res 2017; 6 (04) 269-273
• 34 Adams JE. Single and dual energy X-ray absorptiometry. Eur Radiol 1997; 7 (Suppl. 02) S20-S31
• 35 Bezakova E, Collins PJ, Beddoe AH. Absorbed dose measurements in dual energy X-ray absorptiometry (DXA). Br J Radiol 1997; 70: 172-179
• 36 Chapple CL, Faulkner K, Lee RE, Hunter EW. Radiation doses to paediatric patients undergoing less common radiological procedures involving fluoroscopy. Br J Radiol 1993; 66 (789) 823-827
• 37 Qaseem A, Forciea MA, McLean RM. et al; Clinical Guidelines Committee of the American College of Physicians. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med 2017; 166 (11) 818-839 [published correction appears in Ann Intern Med 2017;167(6):448]
• 38 Kanis JA, Harvey NC, Johansson H, Odén A, Leslie WD, McCloskey EV. FRAX Update. J Clin Densitom 2017; 20 (03) 360-367
• 39 Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010; 17 (01) 25-54 , quiz 55–56
• 40 Hunter DJ, Sambrook PN. Bone loss. Epidemiology of bone loss. Arthritis Res 2000; 2 (06) 441-445
• 41 Tannenbaum C, Clark J, Schwartzman K. et al. Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab 2002; 87 (10) 4431-4437
• 42 Fleeman N, Bagust A, Boland A. et al. Talimogene Laherparepvec for Treating Metastatic Melanoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. PharmacoEconomics 2017; 35 (10) 1035-1046
• 43 Shane E, Burr D, Ebeling PR. et al; American Society for Bone and Mineral Research. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2010; 25 (11) 2267-2294 [published correction appears in J Bone Miner Res 2011;26(8):1987]
• 44 Huprikar NA, Holley AB, Skabelund AJ. et al. A Comparison of Global Lung Initiative 2012 with Third National Health and Nutrition Examination Survey Spirometry Reference Values. Implications in Defining Obstruction. Ann Am Thorac Soc 2019; 16 (02) 225-230
• 45 Solomon DH, Morris C, Cheng H. et al. Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 2005; 80 (02) 194-202
• 46 Das S, Crockett JC. Osteoporosis - a current view of pharmacological prevention and treatment. Drug Des Devel Ther 2013; 7: 435-448
• 47 Watts NB, Adler RA, Bilezikian JP. et al; Endocrine Society. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97 (06) 1802-1822
• 48 Buckley L, Guyatt G, Fink HA. et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care Res (Hoboken) 2017; 69 (08) 1095-1110 [published correction appears in Arthritis Care Res (Hoboken). 2017 Nov;69(11):1776]
• 49 Cosman F, de Beur SJ, LeBoff MS. et al; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25 (10) 2359-2381 [published correction appears in Osteoporos Int 2015;26(7):2045-7]
• 50 Gillespie LD, Robertson MC, Gillespie WJ. et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 2012 (09) CD007146
• 51 Ensrud KE, Ewing SK, Taylor BC. et al; Study of Osteoporotic Fractures Research Group. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 2007; 62 (07) 744-751
• 52 Sherrington C, Fairhall NJ, Wallbank GK. et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1 (01) CD012424
• 53 Lips P. Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 1997; 103 (2A): 3S-8S , discussion 8S–11S
• 54 Savva GM, Donoghue OA, Horgan F, O'Regan C, Cronin H, Kenny RA. Using timed up-and-go to identify frail members of the older population. J Gerontol A Biol Sci Med Sci 2013; 68 (04) 441-446