Incidence and distribution of postcranial fractures in the prehistoric population of San Pedro de Atacama,northern Chile

Trauma incidence analysis in skeletal populations has been very popular among skeletal biologists during the last two decades. In this context, the work of Lovejoy and Heiple ([1981] Am. J. Phys. Anthropol. 55:529–541) has been quoted as a landmark because their analysis rested on a populational approach, avoiding simple assumptions about cause and etiology. In this study, we apply to the prehistoric population of San Pedro de Atacama, northern Chile, an approach similar to that carried out by Lovejoy and Heiple (1981). The results obtained point to a peak of risk of fractures among old people, estimated age around 45 years. The distribution of fractures by sex and age suggests that the prevailing etiology is related to accidents and not violence. When the frequencies of fractures are compared, the Libben population shows a much higher incidence than the Atacamenean population. It is suggested that this difference can be explained by peculiarities of the subsistence economies of the two populations. Am J Phys Anthropol 109:253–258, 1999. © 1999 Wiley-Liss, Inc.     

Anatomical, physiological, and epidemiological correlates of the aging process: a confirmation of multifactorial age determination in the Libben skeletal population

Paleodemographic analyses based on estimates of skeletal age at death consistently report high levels of young adult mortality with few individuals living in excess of 50 years. Critics assert these data indicate systematic underaging of adults and justifiably remark that criteria for estimating skeletal age at death may be unreliable, age determinations are too frequently based on one or two criteria alone, and adult paleodemographic age profiles often mimic the age distribution of the modern population from which an age indicator's standards were originally derived. This study reports a series of tests based on well-documented biological aging phenomena that can be used to investigate potential effects of systematic underaging in adults, assuming the skeletal population is of sufficient size to permit such tests. These include patterns of third decade sternal clavicular epiphyseal fusion, multiple age and sex criteria associated with cortical bone dynamics, and fractures known to occur throughout the entire adult ages range. These phenomena are examined here for the Libben site skeletal population where adult age at death was determined by the multifactorial summary age technique. None of the biological criteria reported here were used in the Libben summary age analysis and thus serve as an independent test of accuracy in age determination. In addition, the summary age method has recently been applied to a series of modern skeletons of known age (Todd samples 1 and 2). Age standards for criteria employed with Libben and Todd 1 were identical. Since Todd 1 displayed underaging in older adults, a second Libben age distribution adjusted for Todd 1 bias was generated for comparison. A third Libben adult survivorship profile based on a Coale and Demeny West level 3 mortality experience, considered by some to be a more realistic model for skeletal populations, was produced for comparison. For all criteria examined, original Libben summary ages provided superior concordance with known patterns of biological aging in human populations. While Libben ages adjusted for Todd 1 bias were slightly better in the third decade, both Todd 1 adjusted and Coale and Demeny West level 3 age distributions produced unrealistic patterns of biological aging for individuals greater than 35 years. Implications of these results are discussed.     

Relative tibia long bone growth in the Libben and Bt-5 prehistoric skeletal populations

Patterns of tibia long bone growth were examined for the Libben Late Woodland and Bt-5 Late Archaic hunter-gatherer skeletal groups. Subadults included in the analyses ranged in age from birth to 10 years. The primary goals were to identify potential differences in relative tibia growth and evaluate the extent to which such differences were concordant with demographic and epidemiological characteristics of the two groups. Methods used were designed to minimize the shortcomings of unknown age and sex of the skeleton, small sample sizes, and population differences in adult size attained. Results showed that Bt-5 preadolescent growth performance and health status in general were superior to those of the Libben group. Modifications in the rate and timing of Libben tibia growth occurred early and were primarily restricted to the weaning period. It is suggested that high levels of infectious disease experienced in the first years of life at Libben played a substantial role in the etiology of early long bone growth retardation, a greater prevalence of iron deficiency anemia in the childhood years, and elevated levels of subadult morbidity and mortality compared to Bt-5. Paleodemographic, paleoepidemiological, and modern comparative population data that support these inferences are discussed. No evidence of chronic malnutrition owing to dietary inadequacy was observed for either group. Alternatively, higher population density and greater degree of sedentism alone may have been responsible for elevated disease loads at Libben compared to low levels that were observed for the seasonally mobile semisedentary Bt-5 hunter-gatherers.     

Fracture rates in patients with growth hormone deficiency

There is some evidence that bone mass is reduced in the majority of adult patients with growth hormone deficiency (GHD), suggesting that such patients have an increased risk of fractures and clinically significant osteoporosis. To date, there have been only two reports of fracture rates in patients with hypopituitarism. Both these retrospective studies show an increased fracture prevalence in this patient group compared with the general population, but patient numbers were low for assessing fracture rates. However, an analysis of data from a large-scale pharmacoepidemiological survey of adults with GHD, KIMS (Pharmacia International Metabolic Database), confirms the findings of these earlier studies. The prevalence of all fractures among patients in KIMS was 2.7 times that in the control population, and the risk of fracture was independent of whether patients had isolated GHD or multiple pituitary hormone deficiencies. The results suggest that GHD is a risk factor for fractures, if a direct endocrine cause is assumed. Notably, there are some data on subgroup analyses from KIMS suggesting that growth hormone replacement therapy may help to reduce fracture risk, although further evidence is needed to confirm this effect.     

Epidemiology of Pelvic Fractures in Germany: Considerably High Incidence Rates among Older People

Epidemiological data about pelvic fractures are limited. Until today, most studies only analyzed inpatient data. The purpose of this study was to estimate incidence rates of pelvic fractures in the German population aged 60 years or older, based on outpatient and inpatient data. We conducted a retrospective population-based observational study based on routine data from a large health insurance company in Germany. Age and sex-specific incidence rates of first fractures between 2008 and 2011 were calculated. We also standardized incidence rates with respect to age and sex in the German population. Multiple Poisson regression models were used to evaluate the association between the risk of first pelvic fracture as outcome and sex, age, calendar year and region as independent variables. The total number of patients with a first pelvic fracture corresponded to 8,041 and during the study period 5,978 insured persons needed inpatient treatment. Overall, the standardized incidence rate of all first pelvic fractures was 22.4 [95% CI 22.0–22.9] per 10,000 person-years, and the standardized incidence rate of inpatient treated fractures 16.5 [16.1–16.9]. Our adjusted regression analysis confirmed a significant sex (RR 2.38 [2.23–2.55], p < 0.001, men as reference) and age effect (higher risk with increasing age, p < 0.001) on first fracture risk. We found a slight association between calendar year (higher risk in later years compared to 2008, p = 0.0162) and first fracture risk and a further significant association with region (RR 0.92 [0.87–0.98], p = 0.006, Westfalen-Lippe as reference). The observed incidences are considerably higher than incidences described in the international literature, even if only inpatient treated pelvic fractures are regarded. Besides which, non-inclusion of outpatient data means that a relevant proportion of pelvic fractures are not taken into account. Prevention of low energy trauma among older people remains an important issue.     

Maxillofacial fractures in the elderly: a comparative study

Previous maxillofacial trauma research has dealt primarily with facial bone fractures in the general population. Very few studies have specifically addressed maxillofacial fractures in the elderly. We compared 45 elderly (65 years of age or older) and 201 younger adult (16 to 64 years of age) patients admitted to our hospital with maxillofacial fractures. The percentage of patients admitted with nasal bone fractures was much greater in the elderly population, while mandibular fractures were more common in the adult group. Motor vehicle accidents accounted for over half the injuries in both groups, while falls were more prevalent in the elderly. Management of the elderly patient may be complicated by their associated injuries or underlying medical problems, perhaps partially accounting for their longer median length of hospital stay. The elderly are a unique subpopulation of maxillofacial fracture patients and deserve further study regarding their injuries and optimal methods for treatment.     

The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in southern norway

Background

Distal radius is one of the most frequent sites for fractures in the elderly population. Despite this, there is a paucity of epidemiological data for distal radius fracture, in particular, distinguishing between high- and low-energy fractures. Our aim was to study the epidemiology of high- and low-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway, and search for associates with high- or low-energy distal radius fracture in this population.

Methodology/Principal Findings

Patients with distal radius fractures aged ≥50 years were identified from all four hospitals in Southern Norway between 2004 and 2005. Age-adjusted and age-specific incidence rates for men and women were calculated, and potential associates with high- and low-energy distal radius fracture were explored both in univariate and multivariate analyses. A total of 799 individuals (118 men and 681 women) aged ≥50 years with low-energy and 84 (48 men and 36 women) with high-energy distal radius fracture were identified. The overall age-adjusted incidence rate per 10,000 person-years was 18.9 for men (low energy, 12.8 vs. high-energy, 6.1) and 75.1 for women (low energy, 71.1 vs. high energy, 4.0). In multivariate model, younger age, male gender, summer season, and living in a rural area were independently associated with an increased risk of high-energy fracture.

Conclusion

An approximately fourfold higher age-adjusted incidence rate for distal radius fracture was found among women, when compared with men. However, the proportion of patients with high-energy distal radius fracture was approximately fivefold higher in men than in women. Our data suggest that younger age, male gender, summer seasons, and living in rural areas are independent risk factors for increased risk of high-energy distal radius fracture.     

Efficacy,cost, and aspects to take into account in the treatment of osteoporosis in the elderly

Age is one of the principal risk factors for development of frailty fractures. Age pyramids show a population that is becoming increasingly more elderly, with an increasing incidence of fractures, and the forecasts for the future are truly alarming. Adequate handling of these patients who are especially at risk, at both the preventive and care levels, with a well-defined orthogeriatric model is necessary to respond to this clinical challenge. The objective of this review is to analyze the efficacy of the different strategies for the handling of geriatric patients with fracture risk.     

When,Where and How Osteoporosis-Associated Fractures Occur: An Analysis from the Global Longitudinal Study of Osteoporosis in Women (GLOW)

Objective

To examine when, where and how fractures occur in postmenopausal women.

Methods

We analyzed data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), including women aged ≥55 years from the United States of America, Canada, Australia and seven European countries. Women completed questionnaires including fracture data at baseline and years 1, 2 and 3.

Results

Among 60,393 postmenopausal women, 4122 incident fractures were reported (86% non-hip, non-vertebral [NHNV], 8% presumably clinical vertebral and 6% hip). Hip fractures were more likely to occur in spring, with little seasonal variation for NHNV or spine fractures. Hip fractures occurred equally inside or outside the home, whereas 65% of NHNV fractures occurred outside and 61% of vertebral fractures occurred inside the home. Falls preceded 68–86% of NHNV and 68–83% of hip fractures among women aged ≤64 to ≥85 years, increasing with age. About 45% of vertebral fractures were associated with falls in all age groups except those ≥85 years, when only 24% occurred after falling.

Conclusion

In this multi-national cohort, fractures occurred throughout the year, with only hip fracture having a seasonal variation, with a higher proportion in spring. Hip fractures occurred equally within and outside the home, spine fractures more often in the home, and NHNV fractures outside the home. Falls were a proximate cause of most hip and NHNV fractures. Postmenopausal women at risk for fracture need counseling about reducing potentially modifiable fracture risk factors, particularly falls both inside and outside the home and during all seasons of the year.     

Do Cadmium, Lead, and Aluminum in Drinking Water Increase the Risk of Hip Fractures? A NOREPOS Study

The aim of this study was to investigate relations between cadmium, lead, and aluminum in municipality drinking water and the incidence of hip fractures in the Norwegian population. A trace metals survey in 566 waterworks was linked geographically to hip fractures from hospitals throughout the country (1994–2000). In all those supplied from these waterworks, 5,438 men and 13,629 women aged 50–85 years suffered a hip fracture. Poisson regression models were fitted, adjusting for age, region of residence, urbanization, and type of water source as well as other possibly bone-related water quality factors. Effect modification by background variables and interactions between water quality factors were examined (correcting for false discovery rate). Men exposed to a relatively high concentration of cadmium (IRR?=?1.10; 95 % CI 1.01, 1.20) had an increased risk of fracture. The association between relatively high lead and hip fracture risk was significant in the oldest age group (66–85 years) for both men (IRR?=?1.11; 95 % CI 1.02, 1.21) and women (IRR?=?1.10; 95 % CI 1.04, 1.16). Effect modification by degree of urbanization on hip fracture risk in men was also found for all three metals: cadmium, lead, and aluminum. In summary, a relatively high concentration of cadmium, lead, and aluminum measured in drinking water increased the risk of hip fractures, but the associations depended on gender, age, and urbanization degree. This study could help in elucidating the complex effects on bone health by risk factors found in the environment.     

Perimenopausal risk of falling and incidence of distal forearm fracture.

A postal survey of 2000 women and 2000 men sampled from the electoral roll in Oxford was undertaken to ascertain whether changes with age in the risk of falling might explain the stepwise increases in age specific incidence rates of distal forearm fracture which occur in women at around the age of 50. Corrected response rates were 83% for women and 72% for men. In women, but not in men, there was a rise in the risk of falling from 45 years, peaking in the 55-59 year age group, and sinking to a nadir at ages 70-74. In both sexes rates rose in extreme old age. These variations were not attributable to preferential response from people who had suffered a fracture. It is concluded that changes in the risk of falling interact with osteoporosis to produce a perimenopausal rise in the incidence of forearm fractures and contribute to the fluctuations in incidence of these fractures in old age.     

The Probability of Death Following a Fracture of the Hip

All patients 45 years of age and over admitted with fractures of the hip to hospitals in the Atlantic Health Region of Nova Scotia were followed up over a two-year period. Actuarial methods were used to estimate survivorship from the date of fracture in 202 patients.Over-all, it was estimated that only 63.8% would be alive by one year post-fracture. This is 70% of the survival rate expected in the general population of corresponding age and sex. The period of greatest mortality was within the first 12 weeks. Patients surviving to one year could be considered “cured”, for after that their survivorship was at least as favourable as that of the “normal” population.Mortality was greatest in males in those 75 years of age and over and especially in patients who were relatively immobilized prior to their fracture. In this “dependent” group the relative survival ratio at one year was only 38%.     

The determinants of fracture in men

Osteoporosis represents an increasingly important clinical and public health problem among older men. Estimates indicated that 1-2 million (3-6%) men aged 50 years and over in the United States have osteoporosis and 8-13 million (28- 47%) have osteopenia. The lifetime risk of suffering a hip, spine or forearm fracture for a 50-year-old man is 13%, similar to the risk for prostate cancer. The number of osteoporotic fractures in men is expected to increase dramatically due to aging of the population and secular increases in fracture rates. Identification of men who are at greatest risk of osteoporosis and the risk factors, which predispose men to fracture, are essential so that preventive steps can be taken. Data on risk factors are emerging but many questions remain. Men may fracture at a higher bone mineral density (BMD) level than women. However, estimates of volumetric BMD, which correct in part for gender differences in bone size, and risk of fracture, may actually show similar relationships in men and women. Fracture rates are similar in older African American women and Caucasian men. Improved understanding of ethnic differences in fracture could identify potential reasons for gender differences. Family history and genetic factors are also important risk factors for fractures but the specific candidate genes are not known and whether gender modifies the effects of these genetic polymorphisms on BMD and the risk of fracture is also not known. In general, lifestyle factors and anthropometric measurements show similar relationships with fractures in men and women although few comprehensive prospective studies have been conducted. Current data will be reviewed on the relationships between markers of skeletal health, genetic polymorphisms, lifestyle and anthropometric factors and fracture.     

Physical activity, skeletal health and fractures in a long term perspective

Exercise during adolescence, especially during the pre-pubertal years, builds a skeleton with a high bone mineral density (BMD) and possibly a larger skeleton with a different skeletal architecture. This would lead to a stronger skeleton more resistant to trauma. These changes could be of biological significance for fracture reduction, if they were maintained into old age where fragility fractures exponentially rise. The Achilles heel of exercise is its cessation. Most BMD benefits achieved by exercise appear to be eroded with cessation of exercise. Reduced exercise intensity after a period of high activity, may maintain some residual BMD benefits into old age. A decreased fracture rate in the population could perhaps be achieved by promoting a physically active life style with lifelong high activity. But what happens if the activity in former athletes is reduced to the same level as in individuals who never exercised? The null hypothesis that exercise has no effect on fracture rates in old age cannot be rejected on the basis of any published, randomised, prospective data. Instead we have to rely on retrospective observational and case control studies, all hypothesis-generating, not hypothesis-testing. Existing data suggest that there could be a reduced fracture risk in former athletes. This notion may be correct, but consistently replicated sampling bias may produce the same observation and any biological explanation for this fracture reduction is unclear. Residual structural skeletal benefits, improved muscle strength, coordination and balance are all traits possibly maintained in former athletes after their active career. These traits may possibly reduce the number of fractures in later life.     

Incident Hip Fractures among Community Dwelling Persons with Alzheimer’s Disease in a Finnish Nationwide Register-Based Cohort

Background

Previous cohort studies have shown that persons with Alzheimer’s disease (AD) have a higher risk of hip fractures but recent data from large representative cohorts is scarce.

Methods

We investigated the association between AD and prevalent and incident hip fractures in an exposure-matched cohort study conducted in Finland 2002–2009 (the Medication and Alzheimer’s disease in 2005 study; MEDALZ-2005). The study population included all community-dwelling persons with verified AD diagnosis in Finland on December 31, 2005 and one matched comparison person per AD case (N = 56,186, mean age 79.9 (SD 6.8) years, range 42–101 years). The diagnosis of AD was extracted from a special reimbursement register. Data on hip fractures during 2002–2009 was extracted from the Finnish National hospital discharge register. Analyses of incident hip fractures (n = 2,861) were restricted to years 2006–2009.

Results

Persons with AD were twice as likely to have previous hip fracture in 2005 (odds ratio, 95% confidence interval 2.00, 1.82–2.20) than matched aged population without AD. They were also more likely to experience incident hip fracture during the four-year follow-up (hazard ratio, 95% confidence interval 2.57, 2.32–2.84, adjusted for health status, psychotropic drug and bisphosphonate use). The AD-associated risk increase decreased linearly across age groups. Although people with AD had higher risk of hip fractures regardless of sex, the risk increase was larger in men than women.

Conclusion

Findings from our nationwide study are in line with previous studies showing that persons with AD, regardless of sex or age, have higher risk of hip fracture in comparison to general population. Although there was some suggestion of effect modification by age or sex, AD was consistently associated with doubling of the risk of incident hip fracture.     

Fracture patterns at the Medieval Leper Hospital in Chichester

Humans are constantly at risk of bone fractures, not only when threatened by personal violence, but also by the challenge of daily living. Because fractures are a cross-cultural phenomenon and are one of the more commonly observed skeletal lesions in archaeological collections, their presence provides a unique opportunity to compare living conditions, and thereby assess fracture risk in coexisting cultures. This study analyzed long bone fracture patterns of 212 sexed adults from the medieval leper hospital of St. James and St. Mary Magdalene in Chichester, England. The comparison of this hospital sample to other British medieval skeletal samples examined the level of health manifest in fracture etiology. The fracture frequency for this sample was 15.1%, with males accounting for 85.4% of the fractures. The fracture frequencies from the samples not affiliated with hospitals ranged from 3.3 to 5.6%. Because medieval urban lifestyle was notoriously difficult due to inadequate sanitation and living conditions, the overall health of the population at large was inferior, placing all at similar fracture risk. Therefore, more specific complications associated with the fractures were examined. Osseous modifications of the skeletons due to lepromatous leprosy were associated with 28% of individuals sustaining fractures. However, persons with the milder tuberculoid leprosy do not exhibit skeletal lesions, but are more prone to accident due to the earlier loss of sensory perception and visual impairment. It is argued that the presence of leprosy is underestimated in archaeological populations and may be a major contributing factor to the prevalence of fracture resulting from accidental falls. Am J Phys Anthropol 105:43–55, 1998. © 1998 Wiley-Liss, Inc.     

Treatment of delayed- and non-union of fractures using pulsed electromagnetic fields

A prospective series of 32 consecutive patients, with 33 long-bone fractures suffering from delayed- or non-union were treated by pulsed electromagnetic fields (PEMF) or by PEMF with surgery. The management regime for the PEMF treatment was simpler and less rigid than that reported by Bassett et al.² and our stimulation waveform was also different. Nineteen fractures (100%) treated with surgery and PEMF united within nine months of the commencement of PEMF treatment. Fourteen fractures were treated with PEMF alone. Twelve (86%) united within ten months and two failed to unite. The resulls of this study suggest that the stimulating waveform is less critical than is claimed by Bassett et al. and that a simpler and easier management regime for PEMF treatment can be just as effective. Alternatively PEMF may have no effect on fracture healing.     

Bone density and risk of hip fracture in men and women: cross sectional analysis.

OBJECTIVE: To determine the relative contribution of decline in bone density to the increase in risk of hip fracture with age in men and women. DESIGN: Incidence data of hip fracture from the general population were combined with the bone density distribution in a sample from the same population and with a risk estimate of low bone density known from literature. SETTING: The Netherlands. SUBJECTS: All people with a hospital admission for a hip fracture in 1993, and bone density measured in a sample of 581.4 men and women aged 55 years and over in a district of Rotterdam. MAIN OUTCOME MEASURE: One year cumulative risk of hip fracture by age, sex, and bone density measured at the femoral neck. RESULTS: A quarter of all hip fractures occurred in men. Men reached the same incidence as women at five years older. Controlled for age, the risk of hip fracture by bone density was similar in men and women. The risk of hip fracture increased 13-fold from age 60 to 80; decrease in bone density associated with age contributed 1.9 (95% confidence interval 1.5 to 2.4) in women and 1.6 (1.3 to 1.8) in men. CONCLUSIONS: The risk of hip fracture by age and bone density is similar in men and women. The decrease in bone density associated with age makes a limited contribution to the exponential increase of the risk of hip fracture with age.     

Patterns of long-bone fracture in two nubian cementeries

The analysis of traumatic fractures can provide valuable information concerning the affects of sociopolitical factors upon the health of prehistoric populations. However, such information can only be acquired by implementing a quantitative demographic approach. The present research applies such a method to longbone fractures in two medieval Christian populations excavated from ancient Nubia. Long-bones of two hundred and eighteen individuals from an early (550 to 750 A.D.) Christian cemetery and 188 individuals from a late (750 to 1450 A.D.) Christian cemetery were examined for evidence of traumatic fracture. Analysis included a determination of fracture rates, age and sex related fracture patterns, and rate of fracture per years at risk. The results of this study indicate that the majority of fractures in both cemeteries were likely caused by accidental falls. Fractures resulting from direct (possibly interpersonal) violence were found in both samples, though at a higher frequency in the early Christian population (27% versus 16%). Middle-aged adults (particularly males) of the early cemetery exhibited a higher than expected risk to fractures indicating an activity related cause of injury. In contrast, the late Christian population showed a marked increase in fractures among both children and the elderly. This distribution may reflect changes in health and residential architecture which occurred during the late Christian period.