Tag Archives: bone mineral density

Do Blondes Have More Bone Fractures?

Two things that are not true about blondes: 1) They have more fun, and 2) they have more bone fractures.

Marilyn Monroe in "Gentlemen Prefer Blondes" movie trailer, posted by MachoCarioca in Wikimedia Commons.

Even if those were true, I suppose they might cancel each other out. But, in fact, the “common wisdom” that people with blond hair or light-colored skin have a higher risk for osteoporosis and bone fractures is a myth. Medical data show that blondes, brunettes and redheads seem to have the same risk for osteoporosis and fractures, Dennis M. Black, Ph.D. said at a conference on osteoporosis sponsored by the University of California, San Francisco.

Another myth: Fracture risk is higher in the northern latitudes of a country, so that people in Minnesota are more prone to fractures than, say, people in Florida. In fact, within the United States, the lowest hip fracture rates are in the northern areas of the country.

That last one was a bit of a trick question, because data have shown that Scandinavians have a higher fracture risk than do equatorial peoples. The incidence of osteoporotic fractures in Norway is 421/ 100,000 people, compared with 1/100,000 in Nigeria. But within any one country, there is no significant north/south difference in fracture rates, said Dr. Black, professor of epidemiology and biostatistics at the university.

So, what does increase a person’s risk of having one of the 1.5 million osteoporotic fractures that occur each year in the United States? Older age and sex, for starters. At age 50 years, a woman’s lifetime risk of fracture exceeds her combined risk of breast, ovarian and uterine cancer. For men who are 50, their lifetime risk of fracture exceeds the risk of prostate cancer. A third of women and a fifth of men will develop osteoporotic fractures in their lifetimes.

Dr. Black (Photo by Sherry Boschert)

Race also is a risk factor. Age-adjusted fracture rates are 968/ 100,000 white people in the United States but only 314/100,000 for U.S. blacks and 219/100,000 for U.S. Hispanics, for example.

A family history of hip fracture doubles your risk for hip fracture, but the same does not apply to spine fractures. More dramatically, having had any kind of nonvertebral fracture yourself increases your risk for any kind of nonvertebral fracture by 1.5- to 3-fold independent of bone mineral density.

Regardless of bone mineral density, smoking doubles your risk for hip fracture, and diabetes doubles your risk for hip or humerus fracture and nearly triples your risk for foot fracture.

Drinking more than two drinks per day boosts the risk of hip fracture by 30%-40% and even more so with higher alcohol consumption. Wine lovers, take note: There is some hint of evidence that hip fracture risk is worse with beer drinking, compared with wine, Dr. Black said.

Of course, bone mineral density is a main predictor of one’s risk for osteoporosis and fracture, but “there is a growing realization that bone mineral density doesn’t tell the whole story and that other risk factors play important and independent roles,” he said.

Clinicians and patients can use the free, online FRAX tool to estimate one’s 10-year risk for fracture by combining many risk factors with bone density. The FRAX is “not without controversy” because it does not include all pertinent risk factors, but it seems to be the best option available when used to guide discussions between physicians and patients about bone health.

Dr. Black has received funding for research, travel or teaching from Merck, Novartis, Roche, and Amgen.

–Sherry Boschert (@sherryboschert)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, IMNG, Internal Medicine, Uncategorized

Does Squatting Prevent Hip Fractures?

Might the demise of squatting in China explain a meteoric rise in hip fractures since 1990?

That’s the notion advanced by Dr. Steven Cummings, a University of California, San Francisco, epidemiologist and osteoporosis researcher, who cited the recent drop in the popularity of squatting as a possible explanation for why hip fracture rates among Beijing residents rose a startling fourfold between 1990 and 2006, a rise that occurred during a period when fracture rates fell in many other locations, including the United States, the United Kingdom, and Hong Kong.

The rise in  fractures in Beijing far exceeded what could have been expected if bone mineral density levels dropped during the period, and no evidence exists that bone mineral density fell during the 16 years studied. In addition, fractures rose despite overall increases in weight among the Chinese, a development that should have led to somewhat denser bones and a reduced hip fracture rate.

image courtesy Flickr user HowiePoon

The lack of any other satisfactory explanation led Dr. Cummings to consider squatting, a posture traditional in China and other eastern countries for people relaxing, eating, or toileting. Squatting, he noted a week ago at the annual meeting of the American Society for Bone and Mineral Research in Toronto, provides “open style” exercise that involves all the muscles of the lower extremities and lower back, may improve balance, may reduce the risk of falls, may help a person control their descent during a fall, and may increase bone mineral density.

 

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Geriatric Medicine, IMNG, Internal Medicine, Primary care, Rheumatology

Still on the Fence About FRAX

Image courtesy of Flickr user Beezum (CC)

Image courtesy of Flickr user Beezum (CC)

from the annual meeting of the American Society for Bone Mineral Research in Denver

It seems that it’s not just the big names in bone mineral research and fracture risk who are divided over the utility of the WHO‘s FRAX fracture risk assessment tool, as suggested in a recent New York Times article.  The rank and file physicians are too, judging from a automated poll at this afternoon’s session on FRAX.

The tool calculates an adult’s 10-year risk of an osteoporotic fracture and a major fracture.  FRAX incorporates not only femoral neck bone mineral density (BMD) but also history of fracture, whether the parents had any fractures, current smoking, the use of glucocorticoids, a diagnosis of rheumatoid arthritis or secondary osteoporosis, and alcohol consumption.

While some physicians have welcomed the tool because it includes factors beyond BMD, others see the tool as flawed, by not including additional factors that also affect bone mineral density.  Some object that the algorithm has not been released and that it lacks validation. Others object that the tool is being used to treat patients when it’s not necessary.

Today’s audience of several hundred was evenly divided over the use of FRAX: 36% said they currently do use the tool and 36% said they do not (the remainder did not see patients).  Numbers like those make FRAX seem as contentious as health care reform.

—Kerri Wachter, @knwachter on Twitter

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Filed under Endocrinology, Diabetes, and Metabolism