Associative factors of existing fragility fractures among elderly medical inpatients: A hospital-based study

Background: Fragility fractures are important in public health because of the increase of morbidity, mortality and cost worldwide. Most fragility fractures occur in patients who have no osteoporosis, but the association with frailty syndrome and cerebrovascular disease is stronger. The main purpose of this study was to evaluate comorbid conditions associated with elderly medical inpatients admitted to the Geriatric Evaluation and Management Unit with existing fragility fractures. Methods: This was a retrospective study screening all medical records of patients admitted to the Geriatric Evaluation and Management Unit of a tertiary medical center from March, 2010 to April, 2011. Patients who had bone mineral density examinations of the hips in the past 5 years were enrolled. Pathological fractures or fractures caused by major trauma were excluded. Demographic characteristics, such as age, sex, height, weight, body mass index, bone mineral density, underlying comorbidity, blood biochemistry, and fracture sites were carefully recorded. Results: Overall, 169 patients (mean age: 84 years, range: 66-96 years; 62.1% male) were enrolled, and fragility fractures were identified in 130 patients, including 115 vertebral fractures, 12 hip fractures and three pelvic fractures. Patients with existing fragility fractures were significantly lower in T score (-2.33 +/- 1.10 vs. -1.87 +/- 1.23, p = 0.030), serum albumin (3.6 +/- 0.4 mg/dL vs. 3.9 +/- 0.4 mg/dL, p = 0.003), total protein (6.4 +/- 0.9 mg/dL vs. 6.9 +/- 0.7 mg/dL, p = 0.007), blood urea nitrogen (20.4 +/- 11.6 mg/dL vs. 26.3 +/- 13.9 mg/dL, p = 0.014), and creatinine (1.0 +/- 0.6 mg/dL vs. 1.4 +/- 0.7 mg/dL, p < 0.001), but not in bone mineral density (0.59 +/- 0.25 g/cm(3) vs. 0.66 +/- 0.16 g/cm(3), p = 0.120) and diagnosis of osteoporosis (41.5% vs. 25.6%, p = 0.073). A multivariate logistic regression model showed that serum levels of albumin < 3.5 mg/dL (odds ratio: 4.6, 95% confidence interval: 1.1e18.2, p = 0.032) and creatinine < 0.8 mg/dL (odds ratio: 10.8, 95% confidence interval: 1.2-97.3, p = 0.033) were significantly associated with existing fragility fractures. Conclusion: For medical patients, fragility fractures were significantly associated with low serum levels of albumin and creatinine, which may be suggestive of malnutrition and low muscle mass. A further prospective study is needed to clarify the sequential effect of fragility fracture, malnutrition and sarcopenia. Copyright (C) 2012, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC.