Risk Factors for Osteoporotic Fracture: A Case Control Study

Abstract

Introduction: Osteoporosis is a global problem and affects every geographical area. Estimates indicate that as many as 50% of Americans older than 50 years will be at risk for osteoporotic fractures during their lifetimes. Hip fracture is also a major public health problem in Asia. It has been projected that by the next century, 50% of all hip fractures in the world will occur in Asia. Rates for women are higher than those for men and rates for all demographic groups increase with age. Older persons have much higher fracture rates than younger persons with the same bone density because of increasing risks from other factors, such as bone quality and tendency to fall. All types of fractures are associated with higher mortality rates. Men are more likely than women to die in the year after a hip fracture, with mortality rates for men estimated at up to 37.5%. This study was done with the aim to find out the risk factors for osteoporotic fracture in Bangladeshi population as there is no such previous studies in Bangladesh. Methods: A case control investigation was done comprising 181 cases admitted with osteoporotic fracture into two tertiary hospitals in Dhaka with 1:1 ratio of age and sex matched controls from July 2017 to June 2019. Information from all subjects was obtained through a questionnaire-based interview. Results: There was a significant increase in the number of cases of osteoporotic fracture with increasing age comprising 88.5% in 61–80-year age group. There were significantly more women (60.7%) than men (39.3%). Univariate analysis identified use of steroid, thyroid medication, loop diuretics, history of previous fracture, kidney disease, arthritis, immobilization, family history of osteoporosis, loss of height and lack of consumption of adequate dairy products (<3 servings/day) as the risk factors of osteoporotic fracture. As expected in multivariate modeling, numerous risk factors had a reduced effect after adjustment for potentially correlated covariates. The statistically significant factors were – use of steroid (OR 3.19, CI 1.10 – 9.22), loop diuretics (OR 5.00; CI 1.29 – 19.46), arthritis (OR 3.49; CI 1.49 – 8.18), family history of osteoporosis (OR 5.45; CI 1.29 – 23.13) and loss of height (OR 2.96; CI 1.27 – 6.88). Conclusions: This study has demonstrated some risk factors associated with osteoporotic fracture such as use of steroid and loop diuretics, arthritis, family history of osteoporosis and loss of height. But some known risk factors for osteoporotic fracture, e.g. lack of physical exercise, immobility, inadequate intake of diet rich in calcium content, caffeine, smoking, immature menopause, etc. were not found statistically significant in this study may be due to small study sample, selection bias or recall bias.

Green Life Med. Col. J. 2025; 10(1): 13-19