Letter to the Editor: “Two-Thirds of All Fractures Are Not Attributable to Osteoporosis and Advancing Age: Implications for Fracture Prevention”

We thank Mai et al. (1) for sharing their interesting study. In the study, 3700 participants aged 50 years and older underwent lumbar spine and femoral neck bone mineral density (BMD) measurements, with fragility fractures assessed by X-ray reports and postfracture mortality as the primary outcomes. Mai et al. (1) thought that the treatment of individuals with osteoporosis was unlikely to reduce a large number of fractures in the general population. However, there are some concerns with this study.

First, Nguyen et al. (2) diagnosed osteoporosis by measured BMD; however, some factors that may have an effect on BMD were excluded, such as diabetes, osteomalacia, and complication of poor nutrition; this underestimated total bone mass because of decreased mineralization of bone (3). Moreover, osteoarthrosis at the spine or hip is common in the elderly, and most findings suggest an inverse relationship between the presence of osteoarthritis and BMD (4).

Second, the study by Mai et al. (1) collected data that included dietary calcium and history of medicine use. However, it did not exclude patients who used anti-osteoporosis drugs, which can decrease the risk of osteoporosis fracture by inhibiting bone resorption and increasing bone formation. Participants, especially postmenopausal women, who used these drugs were less likely to experience fractures, so the prevalence of fractures in their study may have been biased (5). If possible, we recommend that patients who use medications be classified as a comparison group; the authors could then evaluate the effects of medication intake on the prevention of osteoporosis fractures.

Finally, in Table 2, Mai et al. (1) evaluated the magnitude of the association between baseline femoral neck BMD and fracture risk stratified by time of follow-up. However, they considered only BMD and time. As we all know, age is an important independent risk factor for osteoporosis, and low BMD may be attributed to age (6). Therefore, we suggest that age-adjusted BMD be added to allow for more accurate evaluation.

Additional Information

Disclosure Summary: The authors have nothing to disclose.

References and Notes