Skip to main content

Advertisement

SpringerLink
Log in

Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Osteoporosis is a major public health problem in the United States of America and around the world, largely due to the morbidity and mortality associated with osteoporotic fractures. In the past decade, large epidemiologic studies have contributed greatly to our understanding of patients who fracture. However, most studies are limited to postmenopausal white women. In this retrospective review, we analyze data from 185 men and women with acute fragility fractures who received osteoporosis consultations during admission to a single urban hospital between 2001 and 2003. Men and women differed in terms of risk factors for falls and osteoporosis but had areal bone mineral density (BMD) measurements remarkably similar, except at the total hip. Black and Hispanic subjects with fractures were significantly younger than whites yet were much more likely to have serious co-morbidities, such as diabetes mellitus and hypertension. In spite of significantly higher BMD measurements, black patients had the highest rates of vitamin D deficiency and secondary hyperparathyroidism. Patients admitted with hip fractures differed from those with non-hip fractures on a number of important variables. Based on these data, we conclude that elderly subjects admitted to an urban hospital with osteoporotic fractures are a heterogeneous group, with features that vary according to fracture type, gender and ethnicity. Future studies of patients with clinical fragility fractures should include ample numbers of men and ethnic minorities, since differences in underlying risk factors may suggest alternative strategies for fracture prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511S

    Article  PubMed  CAS  Google Scholar 

  2. Tosteson AN, Hammond CS (2002) Quality-of-life assessment in osteoporosis: health status and preference-based measures. Pharmacoeconomics 20:289–303

    Article  PubMed  Google Scholar 

  3. Stevens JA, Olson S (2000) Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep 49:3–12

    PubMed  CAS  Google Scholar 

  4. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761−1767

    Article  PubMed  Google Scholar 

  5. Schneider EL, Guralnik JM (1990) The aging of America. Impact on health care costs. JAMA 263:2335–2340

    Article  PubMed  CAS  Google Scholar 

  6. Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO study group. Osteoporos Int 4:368–381

    Article  PubMed  CAS  Google Scholar 

  7. Kanis JA, Melton LJ, 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    Article  PubMed  CAS  Google Scholar 

  8. Follin SL, Black JN, McDermott MT (2003) Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190–198

    Article  PubMed  Google Scholar 

  9. Juby AG, De Geus-Wenceslau CM (2002) Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 13:205–210

    Article  PubMed  CAS  Google Scholar 

  10. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 109:326–328

    Article  PubMed  CAS  Google Scholar 

  11. Simonelli C, Chen YT, Morancey J, Lewis AF, Abbott TA (2003) Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med 18:17–22

    Article  PubMed  Google Scholar 

  12. Solomon DH, Finkelstein JS, Katz JN, Mogun H, Avorn J (2003) Underuse of osteoporosis medications in elderly patients with fractures. Am J Med 115:398–400

    Article  PubMed  Google Scholar 

  13. Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057

    Article  PubMed  Google Scholar 

  14. Solomon DH, Brookhart MA, Gandhi TK, Karson A, Gharib S, Orav EJ, Shaykevich S, Licari A, Cabral D, Bates DW (2004) Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med 117:919–924

    Article  PubMed  Google Scholar 

  15. Calvo MS, Whiting SJ (2003) Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use. Nutr Rev 61:107–113

    Article  PubMed  Google Scholar 

  16. Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–4130

    Article  PubMed  CAS  Google Scholar 

  17. LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J (1999) Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 281:1505–1511

    Article  PubMed  CAS  Google Scholar 

  18. Lips P (2001) vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477−501

    Article  PubMed  CAS  Google Scholar 

  19. Scharla SH, Wolf S, Dull R, Lempert UG (1999) Prevalence of low bone mass and endocrine disorders in hip fracture patients in southern Germany. Exp Clin Endocrinol Diabetes 107:547–554

    Article  PubMed  CAS  Google Scholar 

  20. Thomas MK, Lloyd−Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783

    Article  PubMed  CAS  Google Scholar 

  21. Birge SJ (1999) Can falls and hip fracture be prevented in frail older adults? J Am Geriatr Soc 47:1265–1266

    PubMed  CAS  Google Scholar 

  22. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB (2004) Effect of vitamin D on falls: a meta-analysis. JAMA 291:1999–2006

    Article  PubMed  CAS  Google Scholar 

  23. Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351

    Article  PubMed  CAS  Google Scholar 

  24. Dhesi JK, Bearne LM, Moniz C, Hurley MV, Jackson SH, Swift CG, Allain TJ (2002) Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res 17:891–897

    Article  PubMed  CAS  Google Scholar 

  25. Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD (2003) Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc 51:1533–1538

    Article  PubMed  Google Scholar 

  26. Janssen HC, Samson MM, Verhaar HJ (2002) vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr 75:611–615

    PubMed  CAS  Google Scholar 

  27. Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the longitudinal aging study Amsterdam. J Clin Endocrinol Metab 88:5766–5772

    Article  PubMed  CAS  Google Scholar 

  28. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639

    Article  PubMed  CAS  Google Scholar 

  29. Kipen E, Helme RD, Wark JD, Flicker L (1995) Bone density, vitamin D nutrition, and parathyroid hormone levels in women with dementia. J Am Geriatr Soc 43:1088–1091

    PubMed  CAS  Google Scholar 

  30. Sato Y, Asoh T, Oizumi K (1998) High prevalence of vitamin D deficiency and reduced bone mass in elderly women with Alzheimer’s disease. Bone 23:555–557

    Article  PubMed  CAS  Google Scholar 

  31. Glowacki J, Hurwitz S, Thornhill TS, Kelly M, LeBoff MS (2003) Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. J Bone Joint Surg Am 85A:2371–2377

    Google Scholar 

  32. Plotnikoff GA, Quigley JM (2003) Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 78:1463–1470

    Article  PubMed  Google Scholar 

  33. Isaia G, Giorgino R, Adami S (2001) High prevalence of hypovitaminosis D in female type 2 diabetic population. Diabetes Care 24:1496

    Article  PubMed  CAS  Google Scholar 

  34. de Laet CE, van der Klift M, Hofman A, Pols HA (2002) Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 17:2231–2236

    Article  PubMed  Google Scholar 

  35. Kroger H, Lunt M, Reeve J, Dequeker J, Adams JE, Birkenhager JC, Diaz Curiel M, Felsenberg D, Hyldstrup L, Kotzki P, Laval-Jeantet A, Lips P, Louis O, Perez Cano R, Reiners C, Ribot C, Ruegsegger P, Schneider P, Braillon P, Pearson J (1999) Bone density reduction in various measurement sites in men and women with osteoporotic fractures of spine and hip: the European quantitation of osteoporosis study. Calcif Tissue Int 64:191–199

    Article  PubMed  CAS  Google Scholar 

  36. George A, Tracy JK, Meyer WA, Flores RH, Wilson PD, Hochberg MC (2003) Racial differences in bone mineral density in older men. J Bone Miner Res 18:2238–2244

    Article  PubMed  Google Scholar 

  37. Luckey MM, Wallenstein S, Lapinski R, Meier DE (1996) A prospective study of bone loss in African−American and white women—a clinical research center study. J Clin Endocrinol Metab 81:2948–2956

    Article  PubMed  CAS  Google Scholar 

  38. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194

    Article  PubMed  Google Scholar 

  39. Sambrook PN, Chen JS, March LM, Cameron ID, Cumming RG, Lord SR, Zochling J, Sitoh YY, Lau TC, Schwarz J, Seibel MJ (2004) Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population. J Clin Endocrinol Metab 89:1572–1576

    Article  PubMed  CAS  Google Scholar 

  40. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642

    Article  PubMed  CAS  Google Scholar 

  41. Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 13:257–264

    Article  PubMed  CAS  Google Scholar 

  42. Dawson−Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676

    Article  PubMed  CAS  Google Scholar 

  43. Larsen ER, Mosekilde L, Foldspang A (2004) vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19:370–378

    Article  PubMed  CAS  Google Scholar 

  44. Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326:469

    Article  PubMed  CAS  Google Scholar 

  45. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 315:1065–1069

    PubMed  CAS  Google Scholar 

  46. Lord SR, Castell S, Corcoran J, Dayhew J, Matters B, Shan A, Williams P (2003) The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc 51:1685–1692

    Article  PubMed  Google Scholar 

  47. Wolf SL, Barnhart HX, Ellison GL, Coogler CE (1997) The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT group. Frailty and injuries: cooperative studies on intervention techniques. Phys Ther 77:371−381; discussion 382–374

    PubMed  CAS  Google Scholar 

  48. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T (2003) Selected as the best paper in the 1990s. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J Am Geriatr Soc 51:1794–1803

    Article  PubMed  Google Scholar 

  49. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999) Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 47:850–853

    PubMed  CAS  Google Scholar 

  50. Binder EF, Brown M, Sinacore DR, Steger−May K, Yarasheski KE, Schechtman KB (2004) Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA 292:837–846

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We would like to thank Louis Bigliani, M.D., Melvin Rosenwasser, M.D., Christopher Michelson, M.D., and Mark Weidenbaum, M.D., as well as other members of the Department of Orthopedic Surgery; Brenda Mallory, M.D., Keith Angell, M.D. and other members of the Department of Rehabilitation Medicine for their tremendous cooperation, support and patient referrals; Peggy Mulligan, N.P. and Joan Valas, N.P. for helping identify and evaluate fracture patients; and Maureen Sheahan, B.S. of Orthopedic Surgery for help in data analysis.

Author information

Authors and Affiliations

  1. Department of Medicine's Metabolic Bone Unit and Toni Stabile Osteoporosis Center, Columbia University College of Physicians and Surgeons, Harkness Pavilion 904, 180 Ft. Washington Avenue, New York, New York, USA

    Carolyn Becker, Don J. McMahon & Ethel Siris

  2. Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA

    Scott Crow, Jared Toman, Carter Lipton & William Macaulay

Authors
  1. Carolyn Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Crow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jared Toman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carter Lipton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Don J. McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William Macaulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ethel Siris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carolyn Becker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becker, C., Crow, S., Toman, J. et al. Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int 17, 410–416 (2006). https://doi.org/10.1007/s00198-005-0001-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-005-0001-1

Keywords

Search

Navigation