Evaluation of relationship between bone mineral density and fragility fracture in perimenopausal women between 40-58 years of age: a hospital based prospective observational study

Authors

  • Arvind Kumar Department of Orthopaedics, CIO, Safdarjung Hospital, New Delhi, Delhi, India
  • Mozammil Pheroz Department of Orthopaedics, CIO, Safdarjung Hospital, New Delhi, Delhi, India
  • Rajesh K. Chopra Department of Orthopaedics, CIO, Safdarjung Hospital, New Delhi, Delhi, India
  • Benthungo Tungoe Department of Orthopaedics, CIO, Safdarjung Hospital, New Delhi, Delhi, India
  • Narendra Kumar Department of Orthopaedics, CIO, Safdarjung Hospital, New Delhi, Delhi, India
  • Yatish Aggarwal Department of Radiodiagnossis, Safdarjung Hospital, New Delhi, Delhi, India
  • Samrin Sarwar Department of Ophthalmology, Safdarjung Hospital, New Delhi, Delhi, India
  • Manoj Soni Department of Orthopaedics, Velmed Hospital, Turner Road, Clement Town, Dehradun, Uttarakhand, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192284

Keywords:

Bone mineral density, Osteoporosis, Perimenopausal female

Abstract

Background: At present the risk assessment for osteoporosis using low bone mineral density (BMD) is based on data obtained from elderly females, largely ≥ 65 years of age. The risk factors for low peak bone mass or accelerated bone loss that occurs during perimenopausal phase is ignored in this risk assessment. Osteoporosis is found to occur at a relatively younger age in the Indian population. Although lower BMD values have an established identity as a major risk factor for fractures in postmenopausal women, we endeavour to evaluate relationship between bone mineral density and fragility fracture in perimenopausal women.

Methods: 65 Patients were recruited for the study. After X-ray of involved part, patients were divided into cases (with fracture, n=33) and control (no bony injury, n=32). All patients underwent dual energy X-ray absorptiometry (DEXA) scan. Results of DEXA scans were evaluated in both the groups. BMD was expressed in g/cm2.

Results: 33 patients (50.77%) were diagnosed as fracture, 32(49.23%) had no bony injury. Threshold bone mineral density (BMD) for fragility fracture found out asfor L1, cut off ≤0.767. For L2, cut off ≤0.829. For L3, cut off ≤0.811. L4, cut off ≤0.798. For L1-L4, cut off ≤0.845. For left femur total hip, cut off ≤0.918. For left forearm-total, cut off ≤0.411. For right femur total hip-cut off ≤0.795. For right forearm-total, cut-off≤0.382.

Conclusions: Perimenopausal women having BMD below threshold for involved site are at risk of fragility fracture and should be given prophylactic treatment to improve bone mineral density.

References

Consensus A. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646-50.

Brown JP, Josse RG, Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167(10):1-34.

Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359(9321):1929-36.

Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM. Risk factors for hip fracture in white women. N Eng J Med. 1995;332(12):767-74.

Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Use of oral corticosteroids and risk of fractures. J Bone Mineral Res. 2005;20(8):1486-93.

Greendale GA, Barrett‐Connor E, Ingles S, Haile R. Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Society. 1995;43(9):955-61.

Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA, et al, IOFCommittee of Scientific Advisors Working Group on Osteoporosis Pathophysiology. Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporosis Int. 2012;23(12):2735-48.

Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254-9.

Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359(9321):1929-36.

Melton III LJ, Achenbach SJ, Gebhart JB, Babalola EO, Atkinson EJ, Bharucha AE. Influence of hysterectomy on long-term fracture risk. Fertility and sterility. 2007;88(1):156-62.

Torgerson DJ, Campbell MK, Thomas RE, Reid DM. Prediction of perimenopausal fractures by bone mineral density and other risk factors. J Bone Mineral Res. 1996;11(2):293-7.

Gupta A. Osteoporosis in India-the nutritional hypothesis. National Med J India. 1996;9:268-74.

Usha G, Krishnaswamy B. Bone mineral density and fracture threshold in South Indian elderly. J Association Physicians of India. 2002;50:247-9.

Earnshaw SA, Cawte SA, Worley A, Hosking DJ. Colles' fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporosis Int. 1998;8(1):53-60.

Hung LK, Wu HT, Leung PC, Qin L. Low BMD is a risk factor for low-energy Colles’ fractures in women before and after menopause. Clin Orthop Related Res. 2005;435:219-25.

Babhulkar SS. Osteoporotic pertrochanteric fractures (fragility fracture). J Orthop Traumatol Rehab. 2014;7(2):108.

Downloads

Published

2019-06-27

Issue

Section

Original Research Articles