Rib fracture cannot be ignored!

Do you consider rib fracture an osteoporotic fracture? If you do, then what are clinical consequences of a rib fracture? My latest study (1) provides some insight into the etiology and impact of rib fracture.

Reporting Rib Fracture Treatment in 2015

Rib fracture illustrated. Source: https://www.aapc.com/blog/29724-reporting-rib-fracture-treatment-in-2015/

Rib fracture is quite common but less documented the elderly. Population based studies suggest that rib fracture accounts for ~1/4 of all incident non-spine fractures in the elderly, with men having a higher risk than women. Surprisingly, risk factors for rib fracture have not been well documented at all. So, we set out to define the association between bone mineral density and rib fracture, and to determine the association between rib fracture and mortality.

We used the data from the Dubbo Study. The Study involved 2040 individuals aged 60 years and older who had been followed for up to 28 years. During the follow-up period, we recorded 59 men and 78 women who had sustained a rib fracture; making the cumulative incidence ~7%. Perhaps, as expected, men and women with a rib fracture were on average older, had lower BMD, and more likely to have a history of fracture and fall. Each 5-year advancing age was associated with a 37% and 47% (P<0.001) increase in the hazard of fracture in men and women, respectively. The presence of a prior fracture increased the risk of subsequent rib fracture by 8.48-fold in men and 3.84-fold in women.

More importantly, we found that patients with a rib fracture were associated with an increased risk of death in the first 12 months post-fracture. Indeed, after adjusting for age and co-morbidities, the risk of mortality was increased by 6 fold in men and ~4 folds in women. That is a significant risk!

In summary, rib fracture is a serious manifestation of osteoporosis, because it is associated with increased mortality risk. We think that individuals with a rib fracture and low bone density should be indicated for treatment. The ‘window of opportunity’ for treatment is within 12 months post-fracture.

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(1) Mai H, et al. Low-trauma rib fracture in the elderly: Risk factors and mortality consequence. Bone 2018;116:295-300.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30172740

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