To the Editor: We have comments regarding the study of high-trauma fractures and low bone mineral density in older women and men by Ms Mackey and colleagues.1 First, it appears that the majority of high-trauma fractures described were due to rather minimal trauma, given that 37.7% of patients in the Study of Osteoporotic Fractures (SOF) cohort and 51.1% in the Osteoporotic Fractures in Men Study (MrOS) cohort sustained fracture due to a fall from more than standing height. This could have contributed to the positive association of osteoporosis with high trauma.
It would be helpful to know whether any persons sustained a low-trauma fracture after a high-trauma fracture or vice versa. This would give more information about underlying osteoporosis, rather than the intensity of trauma, as a cause of increased risk of fracture. Also, fracture at any site would increase the predisposition to further fracture by other mechanisms such as immobility or bone loss.2 In both the cohorts, the persons who sustained fractures (both high- and low-trauma) reported increased incidence of falls in the past year and fracture since age 50 years, suggesting underlying osteoporosis rather than the trauma as the actual risk factor.
Second, in the SOF cohort, 42% of women with bone mineral density scores indicating osteoporosis and about 58% with bone mineral density in the osteopenia range did not sustain fracture over a mean follow-up period of 9 years. This appears contrary to other studies.3 - 4
Third, in the SOF cohort, bone mineral density in the osteopenia range was seen in a similar percentage of women among all 3 subgroups (52.8% with high-trauma fracture, 53.7% with low-trauma fracture, and 57.5% with no fracture). This highlights the importance of looking at factors other than bone mineral density in assessment of future fracture risk.5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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