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Emily Pradko ACF Abstract FY12

"Characteristics of Those with Humeral Fragility Fractures"

International Symposium on Osteoporosis

Background: As the most common bone disease, osteoporosis is estimated to cause fragility fractures in 50% of females and 25% of males over the age of 50 years in the U.S. Although the most common fragility fractures are located in the spine, hip, and wrist, osteoporosis can affect almost the entire skeleton. The objective of this study was to characterize individuals over age 50 who have sustained a humeral shaft fragility fracture requiring surgical fixation.

Materials and Methods: This study is a retrospective case control study of patients 50 years of age or older who were surgically treated for a humeral shaft fracture from a low-energy fall during the period of December 2002 through March 2011 at a Level I trauma center and treated at a large orthopaedic private practice. Patients were excluded who had known metastatic disease, periprosthetic fractures, and incomplete medical records. 299 subjects were identified by CPT codes followed by a retrospective record review regarding the type of fracture, osteoporotic risk factors, and diagnostic and treatment modalities.

Results: Sixty-eight patients included 21 (31%) males, mean age of 73 years (range 55-90), and 47 (69%) females, mean age of 72 years (range 50-92). The average BMI was 30.0 with a range of 18.4 to 50.1. AO/OTA fracture classification included: 20 (29%) 11A, 30 (44%) 11B, 10 (15%) 11C, and 8 with missing injury films. Prior to the current fracture, 18 (27%) had a previous fragility fracture, 13 (19%) were receiving a resorptive therapy for osteoporosis, 12 (18%) had a prior diagnosis of osteopenia/osteoporosis, and 16 (24%) were taking calcium, and 14 (21%) were taking vitamin D. Only 1 of 51 (2%) were evaluated for osteoporosis prior to the implementation of an osteoporosis clinic; whereas 12 of 17 (71%) were evaluated after the clinic was available. As a result of fragility fracture the following diagnostic procedure or treatment was prescribed: weight bearing exercise (38, 56%), calcium (16, 24%), vitamin D (15, 22%), bone scan (10, 15%), medication (10, 15%), and a fall prevention program (3, 4%). The most common identified risk factors for osteoporosis included: history of smoking (30, 44%), arthritis other than rheumatoid (20, 29%), diuretics (20, 29%); thyroid medication (16, 24%), diabetes mellitus (14, 21%), history of corticosteroid use (14, 21%), stroke (14, 21%), COPD (11, 16%), asthma (9, 13%), dementia (8, 12%), and inflammatory bowel disorder (8, 12%).