One of the main parts of my job involves running the “Re-Fracture Prevention Clinic.” As the name suggests, it’s all about preventing further fractures, as having one fracture significantly increases the risk of more. I have the pleasure of screening all patients with fractures treated at my hospital.
Understanding Bone Density and Fracture Risk
Often, people who have had fractures in the past tell me they didn’t start any treatment because their bone-density scan showed “osteopenia only.” However, it’s crucial to understand that if someone has a minimal trauma fracture, such as breaking a hip or vertebra after a fall from standing height, this classifies as osteoporosis, and they should almost always receive treatment.
Interestingly, the majority of fractures actually occur in bones with osteopenia densities. While the risk might be higher in bones with osteoporosis densities, there are far more people with osteopenia.
Conversely, many younger people may have bone density that meets the criteria for osteoporosis, but their actual risk of having a fracture is quite low, and treatment wouldn’t be indicated until they are older. This is because age significantly increases fracture risk due to the decrease in collagen and bone architecture quality, similar to how collagen in our skin decreases with age. For example, a 25-year-old with a bone density of -2.5 has a much lower risk of fracture than an 80-year-old with the same T-score of -2.5.
Other factors that increase fracture risk, regardless of bone density scores, include a history of previous fractures and certain medications, especially prednisone.
Key Takeaways
- Bone Density Scores: These are just one part of the puzzle in assessing fracture risk.
- Minimal Trauma Fractures: If someone has minimal trauma fractures, even with osteopenia, they have clinical osteoporosis and likely should receive treatment.
- Age and Fracture Risk: Osteopenia and low bone densities in younger people have a much lower fracture risk than if they were older. Unless they fracture, they rarely need treatment.
- Screening for Osteoporosis: People who have low/minimal trauma fractures should discuss with their doctor whether they should be screened for osteoporosis.