Impact of non-hip fractures in elderly women: a narrative review

Abstract

The association of hip fractures with adverse outcomes is well established, but for non-hip fractures this association still needs to be further investigated. The objective of this narrative review is to describe the state of the art with regards to the health impact of clinically relevant non-hip fracture locations in postmenopausal women. PubMed and Scopus databases were searched from January 2010 until December 2020. Studies were included when the crude rates and/or relative risk of 1-year subsequent fractures and/or mortality were reported as well as the precise fracture site. Twenty-three studies met the inclusion criteria. Regarding mortality rates, there was a high variability between studies, with higher rates for vertebral, proximal humerus and pelvic fractures. There was a small or no impact of wrist, ankle or tibia fractures. The mortality rate increased with age after vertebral, proximal humerus and wrist fractures. Moreover, proximal humerus and vertebral fractures were associated with a higher mortality risk. This narrative review indicates that, besides fractures of the hip, fractures of the vertebrae, proximal humerus or pelvis deserve more attention when trying to prevent adverse outcomes of osteoporosis. More studies on the topic of non-hip fractures are urgently needed.

摘要

髋部骨折与不良结局之间的关联已得到充分证实, 但对于非髋部骨折, 这种关联仍需进一步研究。本叙述性综述目的是描述绝经后女性临床非髋部骨折相关部位对健康影响的最新进展。在2010年1月∼2020年12月期间, 对PubMed和Scopus数据库进行了搜索, 纳入报道1年后骨折粗发病率和/或相对风险和/或死亡率以及精确的骨折部位的研究。23项研究符合纳入标准。研究之间对于死亡率的报道存在很大差异, 椎体、肱骨近端和骨盆骨折的死亡率率较高。手腕、脚踝或胫骨骨折的影响很小或没有影响。椎体、肱骨近端和腕部骨折后死亡率随年龄增长而增加。此外, 肱骨近端和椎体骨折与较高的死亡率风险相关。本叙述性综述表明, 除了髋部骨折外, 应当更多关注脊椎、肱骨近端或骨盆骨折, 预防骨质疏松症的不良结局。迫切需要更多针对非髋部骨折的研究。

Keywords:

• Non-hip fractures
• mortality
• subsequent fractures
• consequences
• elderly women
• osteoporosis

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.