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Is ankle fracture related to low bone mineral density and subsequent fracture? A systematic review

Osteoporosis and Sarcopenia 2020년 6권 3호 p.151 ~ 159
Therdyothin Atiporn, Phiphopthatsanee Nacharin, Wajanavisit Wiwat, Woratanarat Patarawan, Laohajaroensombat Sukij, Tawonsawatruk Tulyapruek,
소속 상세정보
 ( Therdyothin Atiporn ) - Mahidol University Faculty of Medicine Ramathibodi Hospital Department of Orthopedics
 ( Phiphopthatsanee Nacharin ) - South London and Maudsley NHS Foundation Trust
 ( Wajanavisit Wiwat ) - Mahidol University Faculty of Medicine Ramathibodi Hospital Department of Orthopedics
 ( Woratanarat Patarawan ) - Mahidol University Faculty of Medicine Ramathibodi Hospital Department of Orthopedics
 ( Laohajaroensombat Sukij ) - Mahidol University Faculty of Medicine Ramathibodi Hospital Department of Orthopedics
 ( Tawonsawatruk Tulyapruek ) - Mahidol University Faculty of Medicine Ramathibodi Hospital Department of Orthopedics

Abstract


Objectives: Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture.

Methods: MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or case-control studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified Newcastle-Ottawa Scale.

Results: Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively.

Conclusions: Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked. Moreover, its potential role as an early predictor of future fracture may promote secondary prevention. Further studies with longer follow-up and stricter confounder control are recommended.

키워드

Osteoporosis; Ankle fracture; Bone mineral density; Fracture prediction; Risk factor

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