Review Question - QID 214043

History of two previous vertebral compression fractures is the strongest predictor or future compression fractures in postmenopausal women.

Compression fractures are the most commonly encountered fragility fracture, followed by hip fractures and distal radius fractures. Fragility fractures are directly associated with the degree of bone loss, which is calculated based on DEXA (dual energy x-ray absorptiometry) scans. Osteoporosis is diagnosed when the T-score, which is bone mineral density matched to young controls, is less than -2.5. History of a single vertebral compression fracture carries a 5-fold increased risk of a second vertebral compression fracture and a 5-fold increased risk for a hip fracture. However, the strongest indicator of further compression fractures in postmenopausal women is history of two vertebral compression fractures.

Lee et al. reviewed the effectiveness of bisphosphonates for preventing recurrent fragility fractures. They reported that patients taking bisphosphonates had a lower rate of subsequent fragility fracture and mortality compared to matched controls. They concluded that pain, quality of life, and improved bone mineral density are additional benefits of taking bisphosphonates.

Dang et al. reviewed recurrent fragility fractures in a cross-sectional analysis. They reported on over a million patients with fragility fractures and found an incidence of 5.8% for second fragility fractures within the first year. They concluded that vertebral compression fractures (13.8%) and proximal humerus fractures (13.2%) were most likely to be associated with recurrent fragility fractures.

Incorrect Answers:
Answer 1: Treatment with bisphosphonates decreases the incidence of recurrent fragility fractures.
Answer 2: Age >75 years is not associated with additional fragility fractures.
Answer 3: While T-score of -2.8 is diagnostic of osteoporosis, it is not as predictive of future fragility fractures as having a history of 2 previous vertebral fractures.
Answer 4: Patients with previous hip fractures are at risk for future fragility fractures, but the association is not as high as with previous vertebral fractures.