Rib fracture: new predictor for osteoporotic risk in postmenopausal women
Medwire News: A patient's history of rib fracture could be used as an indicator of osteoporotic fracture risk in postmenopausal women, say researchers.
Hip, spine, and wrist fracture history have been acknowledged as clinical risk factors for future fracture in the revised Clinician's Guide of the National Osteoporosis Foundation. Previous rib fractures, however, are not officially considered when determining osteoporotic risk.
This National Osteoporosis Risk Assessment (NORA) study, led by Elizabeth Barrett-Connor (University of California San Diego, USA) involved 155,031 postmenopausal women between the ages of 50 and 99 years. A cohort of 4758 women reported a baseline history of rib fracture and no other fractures, and was compared to a group of 150,273 with no baseline history of any fracture.
Fracture risk was determined using information gained via a questionnaire about the absence or presence of risk factors for low bone mineral density and fractures. These risk factors included ethnicity, years in education, self-rated health, body mass index, personal and family history of fracture, medicine use, and age at menopause. The women included in this analysis responded to the survey at baseline and to one or more follow-up surveys, either 1, 3, or 6 years after the study began.
The study, published in the journal Osteoporosis International, shows that a history of rib fracture after the age of 45 years increased new rib fracture risk 5.4-fold, plus there was a 2.4-fold increase in risk for any new clinical fracture in these women. A total of 6300 women reported 6830 new fractures, including 2271 wrist fractures, 1891 rib fractures, 1136 clinical spinal fractures, 941 hip fractures, and 591 forearm fractures. Adjusted relative risks were significantly higher in women with rib fracture history compared with those with no fracture history at all reported sites, except at the forearm and the hip.
The researchers acknowledge the limitations of their study, saying that "neither a history of rib fracture nor report of incident fractures was validated by radiography or medical record review." But overall they consider it likely that the majority of fractures reported by the patients were associated with low bone mineral density.
"A history of rib fractures is suggestive of osteoporosis and should be considered when evaluating patients for interventions to prevent fracture," conclude the researchers.
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By Chloe McIvor