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[Secondary osteoporosis in gynecology].

Several diseases and medications are known to induce secondary osteoporosis. Among them, same situations are related to gynecological field. They include Turner's syndrome, anorexia nervosa, ovarian dysfunction, oophorectomy, GnRH agonist therapy, and osteoporosis associated with pregnancy. We briefly describe these secondary osteoporosis in this article as follows. Several studies have found osteoporosis to be a common complication of Turner's syndrome and hormone replacement therapy has been used as a possible management; in anorexic patient, low body weight, prolonged amenorrhea, early onset of anorexia nervosa, and hypercortisolism have been reported to be risks for bone demineralization; since oophorectomy which is a common intervention in gynecology leads osteoporosis, it is important to prevent osteoporosis caused by surgery as well as postmenopausal osteoporosis; GnRH agonist, which induces estrogen deficient state and affect bone mass, is commonly used as a management for endometriosis and leiomyoma of uterus; associated with pregnancy, post-pregnancy spinal osteoporosis and transient osteoporosis of the hip are clinically considered to be important and heparin therapy and magnesium sulfate therapy are commonly employed during pregnancy, affecting calcium homeostasis.

Anorexia Nervosa↗

[Osteoporosis in the man: diagnosis and therapy].

The prevalence of osteoporosis in men has been underestimated in the past. Vertebral fractures were found in about 10% in men of age 50 and over 20 to 30% of all hip fractures in advanced age occur in men. Lower life expectancy of men but also differences in bone geometry and remodeling contribute to the lower rate of fractures in comparison to the female gender. In men with suspected osteoporosis a thorough history, physical and clinical examination is mandatory to exclude other localized or generalized osteopathies and to differentiate in primary and secondary osteoporosis. Only some small studies have been published so far on treatment of osteoporosis in men, i.e. therapeutic decisions are mainly based on existing results in postmenopausal osteoporosis. The basis of treatment is calcium and vitamin D supplementation and individually adapted recommendations on life style and risk factor avoidance. In established osteoporosis in adequate analgesic therapy is very important. In cases with secondary osteoporosis, if possible, etiological therapy should be started. Antiresorptive therapy (e.g. calcitonin, bisphosphonates) or osteoanabolic therapy (e.g. fluoride) can later be added, while in idiopathic osteoporosis this is the first option. According to the existing experiences there is in general a good chance to ameliorate the condition in men. There is however an urgent need for further data on therapy of osteoporosis in men.

Adult↗

The effect of patient education on calcium intake in elderly men at risk for osteoporosis.

OBJECTIVE: To determine the effect patient education has on osteoporosis prevention and calcium intake has on elderly men who are at risk for developing osteoporosis. DESIGN: This was a prospective study in which subjects completed a Men's Osteoporosis Risk Questionnaire and watched a video on osteoporosis prevention. Subjects were then divided into groups based on osteoporosis status and contacted one month later to complete a telephone survey. SETTING: Geriatric ambulatory care clinic in the St. Louis Veteran's Affairs Medical Center. PARTICIPANTS: 35 men over the age of 65. INTERVENTION: Subjects watched a video on osteoporosis prevention. OUTCOMES: Primary outcome was change in calcium intake (total, dietary, and supplemental) in men at risk for osteoporosis. Secondary objectives were new diagnoses of osteoporosis; new fractures; effects on exercise, tobacco and alcohol use; and change from baseline calcium intake between at risk, diagnosed, and no risk for osteoporosis subjects. RESULTS: After watching the educational video, 67% of the subjects increased the amount of calcium ingested, and 10% of the subjects began calcium supplementation. CONCLUSIONS: There were significantly more subjects meeting the RDA of calcium after watching the educational video.

Journal Article↗

Amylin fasting plasma levels are decreased in patients with osteoporosis.

Amylin is a polypeptide hormone produced in pancreatic beta-cells that belongs to the family of calcitonin gene-related peptides. There is a 20% sequence homology between amylin and calcitonin and 44% homology with calcitonin gene-related peptide. Amylin and its fragments stimulate the proliferation of osteoblasts, inhibit bone resorption, and increase bone density and the amount of bone mass. We measured amylin total and unreduced amylin fasting plasma levels in patients with osteoporosis ( n=28; 3 men, 25 women; mean age 65 years), type 2 diabetes mellitus ( n=10; 5 men, 5 women; 64 years), and in the control group ( n=24; 11 men, 13 women; 53 years) using an ELISA kit with immunofluorescent detection (Linco). Amylin total plasma levels in patients with osteoporosis were 3.33+/-0.46 pmol/l (mean+/-SEM), in patients with type 2 diabetes 6.29+/-1.47 pmol/l (mean+/-SEM), and in the control group 8.48+/-3.12 pmol/l (mean+/-SEM). Mean plasma levels were lower in patients with osteoporosis than in patients with type 2 diabetes and in the control group. Unreduced amylin plasma levels in patients with osteoporosis ( n=28) were 2.51+/-0.87 pmol/l (mean+/-SEM), in patients with type 2 diabetes ( n=10) 4.15+/-0.95 pmol/l (mean+/-SEM) and in the control group ( n=5) 13.50+/-3.94 pmol/l (mean+/-SEM). Plasma levels were significantly lower in patients with osteoporosis than in patients with type 2 diabetes ( P<0.01) and in the control group ( P<0.001). Amylin plasma levels are decreased in patients with osteoporosis. Amylin deficiency in these patients may contribute to the development of osteoporosis. Amylin should be investigated in relation to the pharmacological treatment of osteoporosis.

Age Factors↗

Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial.

INTRODUCTION: Older patients with fragility fractures are not commonly tested or treated for osteoporosis. Compared to usual care, a previously reported intervention led to 30% absolute increases in osteoporosis treatment within 6 months of wrist fracture. Our objective was to examine longer-term outcomes, reproducibility, and cost-effectiveness of this intervention. METHODS: We conducted an extended analysis of a non-randomized controlled trial with blinded ascertainment of outcomes that compared a multifaceted intervention to usual care controls. Patients >50 years with a wrist fracture treated in two Emergency Departments in the province of Alberta, Canada were included; those already treated for osteoporosis were excluded. Overall, 102 patients participated in this study (55 intervention and 47 controls; median age: 66 years; 78% were women). The interventions consisted of faxed physician reminders that contained osteoporosis treatment guidelines endorsed by opinion leaders and patient counseling. Controls received usual care; at 6-months post-fracture, when the original trial was completed, all controls were crossed-over to intervention. The main outcomes were rates of osteoporosis testing and treatment within 6 months (original study) and 1 year (delayed intervention) of fracture, and 1-year persistence with treatments started. From the perspective of the healthcare payer, the cost-effectiveness (using a Markov decision-analytic model) of the intervention was compared with usual care over a lifetime horizon. RESULTS: Overall, 40% of the intervention patients (vs. 10% of the controls) started treatment within 6 months post-fracture, and 82% (95%CI: 67-96%) had persisted with it at 1-year post-fracture. Delaying the intervention to controls for 6 months still led to equivalent rates of bone mineral density (BMD) testing (64 vs. 60% in the original study; p = 0.72) and osteoporosis treatment (43 vs. 40%; p = 0.77) as previously reported. Compared with usual care, the intervention strategy was dominant - per patient, it led to a $13 Canadian (U.S. $9) cost savings and a gain of 0.012 quality-adjusted life years. Base-case results were most sensitive to assumptions about treatment cost; for example, a 50% increase in the price of osteoporosis medication led to an incremental cost-effectiveness ratio of $24,250 Canadian (U.S. $17,218) per quality-adjusted life year gained. CONCLUSIONS: A pragmatic intervention directed at patients and physicians led to substantial improvements in osteoporosis treatment, even when delivered 6-months post-fracture. From the healthcare payer's perspective, the intervention appears to have led to both cost-savings and gains in life expectancy.

Aged↗

Osteoporosis: diagnosis and management today and tomorrow.

Osteoporosis is a disease in which low bone mass and microarchitectural deterioration of bone tissue lead to increased bone fragility and a consequent increase in fracture risk. The risk of developing osteoporosis can be assessed by determining the maximum density and strength achieved at maturity (peak bone mass) and the rate and duration of age-associated bone loss. The major cause of osteoporosis is estrogen withdrawal in women, most commonly associated with the menopause, but also with other causes of ovarian failure. Androgen insufficiency in men, although much less common, can also lead to osteoporosis. Measurements of bone mineral density (BMD) have been used to predict fractures, and current evidence suggests that fractures at any site can be predicted by taking measurements of BMD at any other site in the skeleton, using noninvasive techniques such as single or dual energy absorptiometry, quantitative computed tomography and ultrasound, a promising but experimental approach. Rapid bone loss at the start of the menopause is also an important contributing factor to the development of osteoporosis. Levels of biochemical markers of bone turnover in plasma and urine have been found to correlate with rapid and prolonged bone loss. Powerful new assays for estimating bone turnover have emerged and more are being developed. Various combinations of these biochemical tests may be used in conjunction with bone densitometry to predict future risk of osteoporosis and osteoporosis-related fractures. Furthermore, biochemical tests can also be useful in assessing response to therapy. Although many factors, including sex, race, heredity and lifestyle (e.g., calcium intake, minerals, nutrition and exercise), influence the risk of osteoporosis, i.e., they affect peak bone mass and subsequent bone loss, and are of little use in predicting future occurrence.

Biomarkers↗

[Diagnosing osteoporosis in primary care in Spain (ABOPAP 2000 study)].

OBJECTIVE: To discover how osteoporosis is tackled in Spanish primary care before the publication of the semFYC osteoporosis guide. DESIGN: Self-filled questionnaire for primary care doctors sent out by commercial mail (in blocks per province). SETTING: Five thousand family medicine clinics in Spain.Participants. Doctors working in primary care.Measurements. Level of activity relating to osteoporosis in daily consultations (identification of risk factors, screening, who conducts diagnosis and follow-up, level of access to densitometry and specialist) and identification data (province, type of work centre and number of consultations per day). MAIN RESULTS: 414 replies embracing reformed and non-reformed centres from the entire country, with different case overloads. 32.3% stated that osteoporosis treatment was viewed as a preventive activity in their centre and only 35.5% systematically asked for family history of osteoporosis. Osteoporosis screening was high in determined situations (82.9% in vertebral compression, 78.3% in hip fracture) and deficient in others (59.6% in glucocorticoid treatment, 46.6% in colles fractures, 36% in chronic nephropathy, 29.2% in thinness, 17.1% in chronic hepatopathy and 11.8% in treatment for epilepsy or with lithium). 73.9% could not request bone densitometry and 64.3% thought that access to other care levels was complicated. 51.9% said they continued to monitor osteoporosis. The impossibility of requesting densitometry or difficult access conditioned the screening level. There were differences in access according to autonomous communities, with Catalonia having best access to Densitometry (75%), followed by the communities of Madrid, Valencia and Euskadi (30%). CONCLUSIONS: Diagnosis of osteoporosis in primary care is deficient and is partly conditioned by difficulty in access to diagnostic tests and the lack of systematic screening.

Humans↗

Vitamin D in the treatment of osteoporosis revisited.

Interest in vitamin D treatment for osteoporosis has recently been revived because of the focus in various parts of the world on the elderly population, which is predominantly vitamin D deficient, in addition to postmenopausal osteoporosis due to estrogen withdrawal, which has been the central theme of osteoporosis research for many years. Combined use of other agents along with vitamin D has fortified the therapeutic armory against osteoporosis. The recent suggestion of a role of vitamin D receptor polymorphism in the development and progress of osteoporosis, possibly by interfering with its expected action, provoked intense discussions on the role of vitamin D in the pathogenesis and treatment of osteoporosis. Vitamin D receptor polymorphism may explain some of the racial differences in the incidence of osteoporosis and its complications. Responses to vitamin D treatment may also be predicted by vitamin D receptor allelic analysis, though the currently proposed allelic patterns are yet far from being widely accepted. The outlook for vitamin D treatment for osteoporosis may require insight into vitamin D receptor, not only for vitamin D's given form, but also for a possible future form designed to intervene at the genomic level.

Aged↗

Osteoporosis and low bone mass in premenopausal and perimenopausal women.

OBJECTIVE: To characterize the historical, clinical, and biochemical features of 111 young women (age, <55 years) referred for evaluation of osteoporosis or low bone mass. METHODS: Women with a bone mineral density T score < or = -2.0 (N = 111) at one or more anatomic sites (by dual-energy x-ray absorptiometry) were assessed relative to anthropomorphic and biochemical characteristics and risk factors for osteoporosis. RESULTS: Of 111 women with low bone mass or osteoporosis, 73 (66%) had identifiable causes of bone loss, of which estrogen deficiency (menopause, premenopausal estrogen deficiency) and conditions associated with estrogen deficiency (anorexia nervosa, cancer chemotherapy) were the most common. Prolonged use of glucocorticoids was the most common secondary cause of osteoporosis. Of 38 women with no identifiable cause of bone loss, 21 were premenopausal (mean age, 38 +/- 10 years [standard deviation]) and 17 were perimenopausal (mean age, 50 +/- 3 years). The mean lumbar spine T score was -2.18 +/- 1.0 in the premenopausal and -2.51 +/- 0.6 in the perimenopausal women. Nontraumatic fractures were reported by 42% of the premenopausal women and 18% of the perimenopausal women. A family history of osteoporosis was reported by 71% of the premenopausal and 47% of the perimenopausal women. CONCLUSION: Most young women with osteoporosis or low bone mass had estrogen deficiency or another secondary cause of premature bone loss (or both). A subset of premenopausal and perimenopausal women, however, had no identifiable cause of bone loss. The strong family history of osteoporosis, especially in the premenopausal women, provides further support for current theories of a genetic predisposition to osteoporosis.

Adult↗

Bone mineral density screening: assessment of influence on prevention and treatment of osteoporosis.

OBJECTIVE: To assess the effect of bone mineral density (BMD) screening on the decision to initiate preventive or therapeutic measures for osteoporosis. METHODS: We offered low-cost BMD screening by dual-energy x-ray absorptiometry of the lumbar spine and proximal femur in conjunction with National Osteoporosis Week. In an effort to assess whether the availability of the BMD measurements resulted in any medical action by the participants of the screening, we conducted a retrospective telephone survey 9 to 12 months after the screening. RESULTS: In response to a newspaper promotion, 350 subjects underwent BMD screening during a 3- to 4-month period. Of these 332 female and 18 male participants, 83% were Caucasian, 10% were Asian, 5% were Hispanic, and 2% were African American. The mean age was 60 +/- 11 years (range, 29 to 93). Osteoporosis (T-score > or = -2.5) was present in 24% and osteopenia (T-score of -1 to -2.49) in 47% of the subjects. A report was sent to the participant and, if requested, also to a specified physician. Of the 350 participants, 249 (238 women and 11 men) responded to the telephone survey. Of these respondents, 63% had sought medical consultation after the BMD screening. Results of the BMD study led to an increase in calcium intake in 32% of female respondents (48% of those with osteoporosis). After BMD measurement, use of osteoporosis therapy approved by the US Food and Drug Administration increased from 38% to 78% of those with osteoporosis. CONCLUSION: These results suggest that low-cost BMD screening is highly effective in increasing awareness of osteoporosis, prompting medical consultation, and initiating measures for prevention and treatment of osteoporosis.

Adult↗

[Pharmacotherapy of osteoporosis in ambulatory practice and its pharmaceutical aspects].

Within the framework of studies of pharmacotherapy of the diseases of the muscular and skeletal system, the paper aimed to analyze the pharmacotherapy of osteoporosis. The significance of the problems in the field of research of epidemiology of osteoporosis requires the use of all available methods. With regard to the fact that the epidemiological situation in osteoporosis is also reflected in the consumption of drugs, the paper aimed to contribute to the solution of the problem by means of an analysis of the pharmacotherapy of osteoporosis. The results of the analysis have confirmed the relationship between the prevalence of the disease of osteoporosis and drug consumption. The paper demonstrated an increase in the total consumption of drugs prescribed for osteoporosis in 1998 and 1999 in comparison with 1997 as well as an increase in the consumption according to the age and sex. A statistically significant difference was recorded in the consumption of drugs prescribed for osteoporosis with regard to women. The analysis showed changes in the assortment of prescribed drugs as well as changes in the management of the therapy of osteoporosis.

Aged↗

[Osteoporosis: a risk factor for periodontal disease (literature review)].

Osteoporosis is a major public health problem all over the world. Caucasian women have the highest risk. Osteoporosis affects about 10% of the total population but the prevalence among postmenopausal women is more than 30%. It had long been stated that general osteoporosis played no role in the etiology of destructive periodontitis with inflammatory nature. Nevertheless a substantial number of publications in recent years indicated just an opposite relationship. It has been shown that total body calcium and bone density was closely associated with mandibular bone density and several studies have demonstrated close relationship between edentulism and systemic osteopenia. Certain data showed clear relationship between osteoporosis and periodontal disease, and osteoporosis is considered as one of the risk factors for periodontal bone loss. Both osteoporosis and periodontal disease are chronic multifactorial diseases with many genetic and behavioral risk factors and determinants. Both diseases can be successfully controlled by eliminating several risk factors. Estrogen replacement therapy can be protective against both postmenopausal osteoporosis and severe periodontitis in postmenopausal women. Tobacco smoking and diet are also important risk factors for both diseases and genetic factors have also been identified as important risk factors in the etiology of both diseases. Recent epidemiological and clinical data provides limited but convincing evidence suggesting an association between osteoporosis and periodontal disease, and many common risk factors could have been detected in the etiology of both diseases.

Bone Density↗

[Osteoporosis prevention in patients with low energy hip fractures hospitalized in the orthopedic department].

INTRODUCTION: The aim of this study was to investigate the following in patients treated for low energy hip fractures: 1) whether they were using osteoporosis preventative therapy before admission to hospital; 2) whether therapy was initiated before discharge from hospital; 3) the therapy used; and 4) whether they were referred for follow-up treatment for osteoporosis after discharge. MATERIAL AND METHODS: We carried out a retrospective study of medical journals on patients with a hip fracture, brought into the Department of Orthopaedic Surgery in 1997-1998. RESULTS: One hundred and forty-six patients, 80% women and 20% men with an average age of 80.7 years, were hospitalised during this period. Twenty patients had specific risk factors for developing osteoporosis, five patients of whom were taking osteoporosis preventative therapy. On admission, eight patients were in treatment. One patient started treatment during the hospital stay. Forty percent of the patients on discharge were referred for treatment by their GP or at the Department of Internal Medicine. DISCUSSION: Of the patients brought into the Department of Orthopaedic Surgery with low energy hip fractures, 6.2% were given the relevant medical treatment for osteoporosis on discharge from hospital, and only one of these patients started osteoporosis preventative therapy during the stay. As the study shows that 14% of the patients had specific risk factors for developing osteoporosis, only 25% of whom started treatment before admission to hospital, we find a need for osteoporosis preventative therapy in this group of patients.

Aged↗

Osteoporosis-an update.

Osteoporosis is a systemic disease characterized by decrease in bone mass per unit volume, compromised bone strength, which predisposes the affected bone to fracture. This is currently one of the leading causes of morbidity and mortality among elderly over the world. In general, osteoporosis is a silent and progressive disorder that is often brought to attention of the patients or physician only after a fracture. The aetiology of osteoporosis is multifactorial and is related to two main processes: acquisition of peak bone density that occurs at the end of the third decade and loss of bone at menopause, going on to old age. The cardinal features of osteoporosis are pain, fracture and deformity. Bone mineral density measurement is the most reliable diagnostic tool in the early stage of osteoporosis. Management of osteoporosis involves prevention and treatment. The best treatment for osteoporosis is prevention. The risk of osteoporosis can be reduced by increasing peak bone mass or by decreasing the bone loss. It needs to be emphasized that bone mineral density (BMD) peaks at about age 35 and then begins to slowly decline with significant acceleration after menopause.Therefore, the most logical and cost-effective preventive strategies are to encourage young women to stop smoking and avoid excessive use of alcohol. They should also be counseled to exercise regularly and consume adequate amounts of calcium and vitamin D.

Activities of Daily Living↗

[Secondary osteoporosis].

Although primary osteoporosis is much more frequent than other diseases associated with osteopenia, the diagnosis of idiopathic osteoporosis should be made only after the causes of secondary osteoporosis have been excluded. Indeed, therapeutic efficiency in secondary osteoporosis depends mainly on the concomitant treatment of the actual cause of osteopenia. Glucocorticoid-induced osteoporosis is the commonest form of secondary osteoporosis, mainly for doses of prednisone of 0.1 mg/kg/day or greater. Hypogonadism in men and women, idiopathic hypercalciuria and chronic alcoholism in men are other frequent causes of osteopenia. The diagnosis of secondary osteoporosis is based on careful examination as well as biochemical and hormonal investigations. Together with the treatment of the associated disease, correction of other risk factors, calcium supplementation, and a regular program of weight-bearing physical activity may be of benefit to reduce bone loss. As fluoride is able to stimulate bone formation, it is an effective agent in the treatment of glucocorticoid or alcohol-induced osteoporosis.

Adrenal Cortex Hormones↗

Osteoporosis intervention following distal forearm fractures: a missed opportunity?

BACKGROUND: Fractures are a manifestation of osteoporosis, but therapeutic interventions to reduce the risk of recurrent fractures are not widespread. OBJECTIVE: To identify predictors of osteoporosis treatment in postmenopausal women following distal forearm fracture. METHODS: This population-based retrospective cohort study included all postmenopausal women, 45 years or older, residing in Olmsted County, Minnesota, who sustained a distal forearm fracture due to minimal trauma (a fall from standing height or under) in 1993 to 1997. Complete medical records were reviewed for each subject and Cox proportional hazards regression was used to evaluate the relationship of baseline demographic and clinical characteristics to therapeutic interventions for osteoporosis within 12 months following the fracture. RESULTS: A total of 343 women with a mean age of 70.5 years had a minimal trauma distal forearm fracture. Within 12 months, 83% had seen a nonorthopedic physician. Of these, 17% had a pharmacologic osteoporosis intervention and the 12-month actuarially estimated cumulative incidence of any intervention was 18% (95% confidence interval [CI], 14%-22%). In a multivariate analysis, treatment was more likely to be offered to those with a prior diagnosis of osteoporosis (relative risk [RR], 2.08; 95% CI, 1.21-3.58), previous distal forearm fracture (RR, 2.38; 95% CI, 1.30-4.34), or history of cigarette smoking (RR, 1.86; 95% CI, 1.11-3.12). CONCLUSIONS: Effective osteoporosis interventions are underutilized among postmenopausal women who experience an osteoporotic fracture. Further work is needed to overcome barriers to optimal osteoporosis management in these women who are at high risk for future complications of osteoporosis.

Cohort Studies↗

Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis.

BACKGROUND: There is an increased prevalence of osteoporosis among patients with celiac disease. However, the relative prevalence of celiac disease among osteoporotic and nonosteoporotic populations is not known, and the benefit of screening the osteoporotic population for celiac disease remains controversial. METHODS: We evaluated 840 individuals, 266 with and 574 without osteoporosis, from the Washington University Bone Clinic by serologic screening for celiac disease. Individuals with positive serologic test results for antitissue transglutaminase or antiendomysial antibody were offered endoscopic intestinal biopsy to confirm the diagnosis of celiac disease. Individuals with biopsy-proven celiac disease were treated with a gluten-free diet and followed up for improvement in bone mineral density. RESULTS: Twelve (4.5%) of 266 patients with osteoporosis and 6 (1.0%) of 574 patients without osteoporosis tested positive by serologic screening for celiac disease. All but 2 serologically positive individuals underwent in-testinalbiopsy. Nine osteoporotic patients and 1 nonosteoporotic patient had positive biopsy results. The prevalence of biopsy-proven celiac disease was 3.4% among the osteoporotic population and 0.2% among the nonosteoporotic population. All biopsy-positive individuals tested positive by antitissue transglutaminase and antiendomysial antibody. The antitissue transglutaminase levels correlated with the severity of osteoporosis as measured by T score, demonstrating that the more severe the celiac disease the more severe the resulting osteoporosis. Treatment of the patients with celiac disease with a gluten-free diet resulted in marked improvement in T scores. CONCLUSIONS: The prevalence of celiac disease among osteoporotic individuals (3.4%) is much higher than that among nonosteoporotic individuals (0.2%). The prevalence of celiac disease in osteoporosis is high enough to justify a recommendation for serologic screening of all patients with osteoporosis for celiac disease.

Absorptiometry, Photon↗

The impact of osteoporosis on patients with maxillofacial trauma.

BACKGROUND: Although maxillofacial injuries in the elderly population frequently result from falls and motor vehicle crashes, the association between osteoporosis and fractures of the maxillofacial region remains poorly defined. OBJECTIVE: To evaluate the relationship between osteoporosis and maxillofacial trauma in the elderly. DESIGN, SETTING, AND MAIN OUTCOME MEASURES: A retrospective review of 59 patients 60 years or older treated for maxillofacial fractures at a trauma center between 1989 and 2000 was performed. The severity of osteoporosis was graded by evaluating the radiographic appearance of the vertebral bodies of each trauma patient using the Saville index. The number of maxillofacial fractures and the severity of osteoporosis in each patient was assessed to determine whether an association between osteoporosis and maxillofacial trauma exists. RESULTS: Of the 59 patients evaluated, 51% were injured by falls and 46% were involved in motor vehicle crashes. Seventy-three percent of the patients had multiple facial fractures. As the severity of osteoporosis worsened, patients were more likely to sustain a greater number of maxillofacial fractures (P=.01). The mechanism of injury had no impact on the relationship between osteoporosis and the number of fractures. CONCLUSIONS: Osteoporosis is an independent risk factor for the development of maxillofacial fractures. Since more than half of these patients are injured by falls, safety measures must be instituted to prevent fall-related maxillofacial injuries in the home and the community.

Accidental Falls↗