The nine million osteoporotic fractures that occur worldwide each year give us reason for concern, and recently colleagues to the north asked two interesting questions about who fractures and how much.

Question #1

How much of the Canadian fracture burden occurs in folks with an osteoporotic bone density, and how much in those with osteopenic or normal bone density?

This question has been asked before, and the Canadian answer was similar to results from around the world — the majority of all Canadian low trauma, “osteoporotic” fractures among both women and men actually occur in folks who have osteopenia or even normal bone density. While those with an osteoporotic bone density have a higher fracture rate, more people have osteopenia, so most fractures occur in this group.

Question #2

How much of the fracture burden is attributable to first versus repeat fractures?

This inquiry I rate as both original and insightful. So what would be your guess — mostly first fractures perhaps? Yes, using data from the 8-year follow-up Canada wide CAMOS study, researchers found that indeed most fractures were first fractures, but surprisingly a full 40% of all fractures in women and 25% in men were repeat fractures.

Further, repeat fractures occurred in equal proportions among those with osteoporosis and those with osteopenia. We've been told before that having a past fracture is one of the best predictors of future fracture, but I believe that we're just starting to understand that the first low-trauma fracture is likely a screaming red flag regardless of your bone density, and a sign that you need to take action to support your bone health. (For those interested in avoiding any fracture, we suggest you look at our Bone Health Profile).

Reference:

Langsetmo, L, Goltzman, D, et al. 2009. Repeat low-trauma fractures occur frequently among men and women who have osteopenic BMD. J Bone Miner Res, 24(9):1515-1522.