Summary
Hip fracture in patients under age 50 is rare, and is often not attributable solely to the energy of injury. Our aim was to determine if trabecular bone mineral density (BMD) is abnormal in young patients with hip fractures. We reviewed all hip fractures treated at our institution between 1979 and 1986 and contacted 20 patients under the age of 50 at the time of injury, all of whom wished to be studied. The mean age at the time of injury was 39 (range 24–47). Subjects were questioned for osteoporosis risk factors, classified by level of energy producing their injury, and then underwent quantitative computed tomography (QCT) bone densitometry of trabecular bone in the lumbar spine. Bone mineral density by QCT was below the mean for age in 90% of the patients, and was greater than 1 SD below the mean in 75%. Mean percentage BMD decrease from age-matched controls was 34% (P<0.005) in women and 19% (P<0.005) in men. There was an inverse correlation in the degree of BMD decrease and the energy level of injury. There was a direct correlation of the severity of BMD decrease and the cumulative number of osteoporosis risk factors. This investigation has found that 1–7 years following hip fracture, otherwise presumedly healthy young patients demonstrate a statistically significant decrease in spinal BMD from age/sex-matched controls. These data do not determine if osteopenia is the cause or the result of injury, nor do we wish to infer that measurement of bone density at one site can predict future fractures at other sites. However, as current thinking supports continuous age-related BMD decrease, this young group of patients with relatively low BMD for their age may be at increased risk for future development of more severe osteopenia. These findings suggest that the significance of hip fractures in young patients may currently be underestimated, and such patients may provide the unique opportunity for early identification of a group at increased risk for developing osteoporosis.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Cummings SR, Kelsey JL, Nevitt MC, and O'Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208
Kelsey JL, White AA, Pastides H, Bisbee GE (1979) The impact of musculoskeletal disorders on the population of the United States. J Bone Joint Surg 61-A: 959–964
Lane JM, Vigorita VJ (1984) Osteoporosis. Orthop Clin North Am 15: 711–728
Riggs BL, Melton LJ (1986) Involutional osteoporosis. N Engl J Med 314: 1676–1686
Richardson ML, Genant HK, Cann CE, Ettinger B, Gordan GS, Kolb FO, Reiser UJ (1985) Assessment of metabolic bone diseases by quantitative computed tomography. Clin Orthop 195:224–238
Schneider R (1984) Radiologic methods of evaluating generalized osteopenia. Orthop Clin North Am 15(4):631–651
Lizaur-Utrilla A, Orts AP, Del Campo FS, Barrio JA, Carbonell PG (1987) Epidemiology of trochanteric fractures of the femur in Alicante, Spain, 1974–1982. Clin Orthop 218:24–31
McBroom RJ, Hayes WC, Edwards WT, Goldberg RP, White AA (1985) Prediction of vertebral body compressive fracture using quantitative computed tomography. J Bone Joint Surg 67-A:1206–1214
Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB, Johnson KA, Melton LJ (1982) Changes in bone mineral density of the proximal femur and spine with aging. J Clin Invest 70:716–723
Grande F, Keys A (1980) Body weight, body composition and calorie status. In: Goodhart RS, Shils ME (eds) Modern nutrition in health and disease, 6th ed. Philadelphia, Lea & Febiger, pp 3–34
Cann, CE, Genant HK, Kolb FO, Ettinger B (1985) Quantitative computed tomography for prediction of vertebral fracture risk. Bone 6:1–7
Aitken JM (1984) Relevance of osteoporosis in women with fracture of the femoral neck. Br Med J 288:597–601
Bohr H, Schaadt O (1983) Bone mineral content of femoral bone and lumbar spine measured in women with fracture of the femoral neck by dual photon absorptiometry. Clin Orthop 179:240–245
Cummings SR (1985) Are patients with hip fractures more osteoporotic? Am J Med 78:487–494
Jensen GF, Christiansen C, Boesen J, Hegedus V, Transbol I (1982) Epidemiology of postmenopausal spinal and long bone fractures. Clin Orthop 166:75–81
Iskrant AP (1968) The etiology of fractured hips in females. 58(3):485–490
Knowelden J, Buhr AJ, Dunbar O (1964) Incidence of fractures in persons over 35 years of age. Br J Prev Soc Med 18:130–141
Alffram PA (1964) An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population. Acta Orthop Scand (suppl) 65:9–109
Alffram PA, Bauer GCH (1962) Epidemiology of fractures of the forearm. J Bone Joint Surg 44-A:105–114
Zetterberg CH, Irstam L, Andersson GB (1982) Femoral neck fractures in young adults. Acta Orthop Scand 53:427–435
Buchanan JR, Myers C, Greer RB, Lloyd T, Varano LA (1987) Assessment of the risk of vertebral fracture in menopausal women. J Bone Joint Surg 69-A:212–218
Finkelstein JS, Klibanski A, Neer RM, Greenspan SL, Rosenthal DI, Crowley WF (1987) Osteoporosis in men with idiopathic hypogonadotropic hypogonadism. Ann Intern Med 106:354–361
Genant HK, Ettinger B, Cann CE, Reiser U, Gordan GS, Kolb FO (1985) Osteoporosis: assessment by quantitative computed tomography. Orthop Clin North Am 16(3):557–568
Ruegsegger P, Dambacher MA, Ruegsegger E, Fischer JA, Anliker M (1984) Bone loss in premenopausal and postmenopausal women. J Bone Joint Surg 66-A:1015–1023
Ruegsegger P, Stebler B, Dambacher M (1982) Quantative computed tomography of bone. Mayo Clinic Proc 57(suppl):96–103
Genant HK, Cann CE, Ettinger B, Gordan GS (1982) Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy Ann Intern Med 97:699–705
Meier DE, Orwoll ES, Jones JM (1984) Marked disparity between trabecular and cortical bone loss with age in healthy men. Ann Intern Med 101: 605–612
Ruegsegger P, Elsasser U, Anliker M, Gnehm H, Hanspeter K, Prader A (1976) Quantification of bone mineralization using computed tomography. Radiology 121:93–97
Aitken JM, Smith CB, Horton PW, Boyd JF, Smith DA (1974) The interrelationships between bone mineral at different skeletal sites in male and female cadavera. J Bone Joint Surg 56-B:370–375
Jhamaria NL, Lal KB, Udawat M, Banerji P, Kabra SG (1983) The trabecular pattern of the calcaneum as an index of osteoporosis. J Bone Joint Surg 65-B:195–198
Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ (1981) Differential changes in bone mineral density of the appendicular and axial skeleton with aging. J Clin Invest 67:328–335
Rockoff SD, Sweet E, Bleustein J (1969) The relative contribution of trabecular and cortical bone to the strength of human lumbar vertebrae. Calcif Tissue Res 3:163–175
Wasnich RD, Ross PD, Helbrun LK, Vogel JM (1985) Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol 153(7):745–751
Wasnich RD, Ross PD, Heilbrun LK, Vogel JM (1987) Selection of the optimal skeletal site for fracture risk prediction. Clin Orthop 216:262–269
Wilson CR (1977) Bone-mineral content of the femoral neck and spine versus the radius or ulna. J Bone Joint Surg 59-A: 665–669
Baran DT, Tettelbaum SI, Bergfeld MA, Parker G, Crubant EM, Avioli LV (1980) Effect of alcohol ingestion on bone and mineral metabolism in rats. Am J Physiol 238:E507-E510
Daniell HW (1976) Osteoporosis of the slender smoker. Arch Intern Med 136:298–304
Nilsson BE (1970) Spinal osteoporosis and femoral neck fracture. Clin Orthop 68:93–95
Simkin A, Ayalon J, Leichter I (1987) Increased trabecular bone density due to bone-loading exercises in postmenopausal osteoporotic women. Calcif Tissue Int 40:59–63
Williams AR, Weiss NS, Ure CL, Ballard J, Daling JR (1982) Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. J Obstet Gynecol 60:695–699
Cohn SH, Abesamis C, Yasumura S, Aloia JF, Zanzi I, Ellis KJ (1977) Comparative skeletal mass and radial bone mineral content in black and white women. Metabolims, 26(2):171–178
Gyepes M, Mellins HZ, Katz I (1972) The low incidence of fracture of the hip in the negro. JAMA 181(12):1073–1074
Mulder H, Hackeng WHL, Silberbusch J (1979) Racial differences in serum-calcitonin. Lancet ii:154
Gallagher JC, Melton LJ, Riggs BL, Bergstrath E (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 150:163–171
Seeman E, Melton LJ, O'Fallon WM, Riggs BL (1983) Risk factors for spinal osteoporosis in men. Am J Med 75:977–983
Van Hemert AM, Vandenbroucke JP, Birkenhage JC, Trouerbach WT, Valkenburg HA (1986) The quantification of risk factors for the development of osteoporosis and osteoporosis-related fractures in middle-aged women. Calcif Tissue Int 39(suppl): A17
Cann CE, Genant HK, Young DR (1980) Comparison of vertebral and peripheral mineral losses in disuse osteoporosis in monkeys. Radiology 134:525–529
Cann CE, Genant HK (1980) Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr 4(4): 493–500
Cann CE, Genant HK, Ettinger B, Gordan GS (1980) Spinal mineral loss in oopherectomized women. JAMA 244(18): 2056–2059
Rosenthal DI, Ganott MA, Wyshak G, Slovik DM, Doppelt SH, Neer RM (1985) Quantitative computed tomography for spinal density measurement—factors affecting precision. Invest Radiol 20(3): 306–310
Laval-Jeantet AM, Roger B, Bouysee S, Bergot C, Mazess RB (1986) Influence of vertebral fat content on quantitative CT density. Radiology 159:463–466
Laval-Jeantet AM, Cann CE, Roger B, Dallant P (1984) A postprocessing dual energy technique for vertebral CT densitometry. J Comput Assist Tomogr 8(6):1164–1167
Mayor GH, Garn SM, Sanchez TV, Shaw HA (1976) The need for differential bone mineral standards for blacks. Am J Roentgenol 126:1293–1294
Aaron JE, Gallagher JC, Anderson J, Stasiak L, Longton ER, Nordin BEC, Nicholson M (1974) Frequency of osteomalacia and osteoporosis in fractures of the proximal femur. Lancet i:229–233
Mosekilde J, Mosekilde LE, Danielsen CC (1986). Age-related changes in vertebral trabecular bone mechanical competence in normal individuals. Calcif Tissue Int 39(suppl):A61
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Boden, S.D., Labropoulos, P. & Saunders, R. Hip fractures in young patients: Is this early osteoporosis?. Calcif Tissue Int 46, 65–72 (1990). https://doi.org/10.1007/BF02556089
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02556089