[First fracture in patients with osteoporosis : How does the "fracture career" of our patients with osteoporosis begin?]

backgroundGiven that a primary osteoporotic fracture can result in subsequent fractures and that the precise etiology of the typical fracture cascade remains uncertain, it is pertinent to determine the initiating factor and the specific fracture involved in this cascade.

methodAll patients with a fracture of a long bone were consecutively screened over the 12-month study period. All participants were asked about existing risk factors (including previous fractures) in accordance with the applicable guidelines of the Umbrella Organization Osteology (DVO). The existing risk factors were employed to calculate the fracture risk and this formed the basis of the diagnosis and indications for treatment.

resultsA total of 613 patients were included in the study. Of the total number of patients 378 were deemed to require pharmacological treatment for osteoporosis. In this cohort 182 fractures were reported. Among the previous fractures distal radius fractures were the most common, occurring in 54 patients followed by fractures of the proximal femur (n = 40) and proximal humerus (n = 27). As anticipated, a breakdown of the data by gender revealed a different picture. In line with the incidences it can be seen that men have fewer distal radius fractures and more fractures close to the hip joint. DISCUSSION: The results indicate that women with a distal radius fracture have the potential to facilitate an early diagnosis and subsequent treatment for osteoporosis. In contrast, in men fractures in the region of the hip joint were the most common initial presentation, precluding the possibility of deriving an early indication of the presence of osteoporosis from previous fractures.