Proportion and Risk Factors of Silent Vertebral Fractures Among Egyptian Females With Fragility Hip Fracture Presenting to the Emergency Room of Ain Shams University Hospitals

Abstract

Background Fragility fractures caused by osteoporosis are known to increase the risk of further fragility fractures. Also, several factors have been associated with an increasing risk of fracture in postmenopausal women with osteoporosis, as prior fracture, advancing age, low bone mineral density (BMD), greater risk or history of falls certain, pharmacologic therapies such as glucocorticoids, and medical conditions increase the risk of secondary osteoporosis and related fractures through their direct impact on bone density or structure. Menstrual history including age at menarche menopause and a history of amenorrhea is documented as a predicting osteoporotic fracture. Objective The aim of the current study is to find the proportion of hidden vertebral fractures among Egyptian females with fragility hip fracture. Patients and methods A cross-sectional study was conducted on patients who presented to the orthopedic emergency room (ER) of Ain Shams University Hospitals in Cairo, Egypt, from September 2020 to September 2021. Our inclusion criteria include females aged 40 years or older, who presented to the ER with fragility hip fractures. A simple random sample of females fulfilling our inclusion criteria for osteoporotic hip fracture was thoroughly investigated. Conventional lateral and anteroposterior radiographs of the dorsolumbar spine were obtained excluding those with high-impact fractures or pathological fractures. Results During the study period, a total of 43,935 persons presented to the orthopedic ER, of whom 30,901 were females, comprising 70.03% of total orthopedic ER visits. A sample of 150 females met our inclusion criteria. Results showed that 16 of our 150 cases had concomitant vertebral fracture, meaning that 10.7% of cases had hidden vertebral fracture at the time of osteoporotic hip fracture, as diagnosed by the screening lumbosacral plain X-rays. Older age at menarche, younger age at menopause, and amenorrhea are shown to be risk factors for hidden vertebral fracture in Egyptian females. Conclusion Osteoporosis is a complex and costly disease. Osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. Concomitant hidden vertebral fracture is prevalent among females with osteoporotic hip fractures, and those who had later menarche, earlier menopause, and menstrual irregularities have a higher incidence of developing associated vertebral fracture, which warrants identification and management to evade complications and mortality.

Las fracturas por fragilidad causadas por la osteoporosis son conocidas por aumentar el riesgo de fracturas por fragilidad adicionales. Varios factores se han asociado con un riesgo creciente de fractura en mujeres posmenopáusicas con osteoporosis, como fracturas previas, edad avanzada, baja densidad mineral ósea (DMO), mayor riesgo o antecedentes de caídas, ciertas terapias farmacológicas como los glucocorticoides y las condiciones médicas que aumentan el riesgo de osteoporosis secundaria y fracturas relacionadas a través de su impacto directo en la densidad o estructura ósea. La historia menstrual, que incluye la edad al momento de la menarquia, la menopausia y antecedentes de amenorrea, se ha documentado como un predictor de fractura osteoporótica. El objetivo del estudio actual es encontrar la proporción de fracturas vertebrales ocultas entre las mujeres egipcias con fractura de cadera por fragilidad. Se realizó un estudio transversal en pacientes que se presentaron a la sala de emergencias ortopédicas del Hospital de la Universidad de Ain Shams en El Cairo, Egipto, desde septiembre de 2020 hasta septiembre de 2021. La fractura vertebral oculta concomitante es prevalente entre las mujeres con fracturas de cadera osteoporóticas, y aquellas que tuvieron una menarquia tardía, menopausia temprana e irregularidades menstruales tienen una mayor incidencia de desarrollar fracturas vertebrales asociadas, lo que justifica su identificación y manejo para evitar complicaciones y mortalidad.