Dear Editor-in-Chief
Lower body fracture is a serious phenomenon due to its notable morbidity and mortality among older population. Supplements like calcium and vitamin D may promote fracture healing. The objective of this study was to determine the risk factors of osteoporosis and post-discharge supplements among older adults with lower body fracture.
In this study, 129 patients were recruited during ward admission phase. All information was collected at the ward by questioning the patients and was tabulated in Table 1. At three-month post discharged, patients were followed up for their dietary supplementation status and the data was tabulated in Table 2.
Table 1:
The demographic and risk factors of osteoporosis for patients with lower body fracture
| Demographic data | Frequency (%), N=129 |
|---|---|
| Age (mean ± SD) | 71.29 ± 10.94 |
| Age group (yr) | |
| Middle age (50–64) | 39 (30.2) |
| Older age (>65) | 90 (69.8) |
| Ethnic/Race | |
| Malay | 48 (37.2) |
| Chinese | 59 (45.7) |
| Indian | 22 (17.1) |
| Gender | |
| Male | 50 (38.8) |
| Female | 79 (61.2) |
| Fracture type | |
| Hip fracture | 78 (60.5) |
| Other than hip fracture | 51 (39.5) |
| Risk Factors of Osteoporosis | |
| Family history of osteoporosis | |
| Yes | 14 (10.9) |
| No | 115 (89.1) |
| Fracture history | |
| Yes | 33 (25.6) |
| No | 96 (74.4) |
| Number of co-morbidities | |
| 0–2 | 88 (68.2) |
| ≥ 3 | 41 (31.8) |
| Milk intake status | |
| Yes | 46 (35.7) |
| No | 83 (64.3) |
| Smoking status | |
| Current smoker | 19 (14.7) |
| Past smoker | 21 (16.3) |
| Never a smoker | 89 (69.0) |
| Alcohol intake status | |
| Current alcohol drinker | 11 (8.5) |
| Past alcohol drinker | 16 (12.4) |
| Never an alcohol drinker | 102 (79.1) |
| Physical activity status | |
| Frequent | 31 (24.0) |
| Occasional | 7 (6.7) |
| Not active | 91 (70.5) |
Table 2:
Dietary supplementation and drugs intake three months post-discharged
| Dietary Supplements and Drugs Intake | Frequency (%), N=89 |
|---|---|
| Calcium | |
| Yes | 72 (80.9) |
| No | 17 (19.1) |
| Vitamin D | |
| Yes | 49 (55.1) |
| No | 40 (44.9) |
| Anti-Osteoporosis drugs | |
| Yes | 2 (2.2) |
| No | 87 (97.8) |
Majority of the lower body fracture patients were in the older age category (>65 yr old). Chinese ethnicity, female and sustaining a hip fracture represented the majority of patients. Majority of the patients did not have fracture history and osteoporosis history in their family. This agreed with a study in Malaysia that revealed family history of osteoporosis and fracture history were not the significant risk factors for fragility fracture (1). For the comorbidities, majority of the patients were in the group of 0–2 diseases and was in accordance to Endo et al, which showed most fracture patients had 0–2 comorbidities (2). In terms of milk intake, majority of the patients did not take milk supported by Norimah et al, that most Malaysian population did not take milk as a daily consumption (3). In terms of smoking status, the highest percentage of patients were non-smoker which might be due to self-awareness regarding the dangerous effects of smoking among the Malaysian population (4). For alcohol intake status, most patients did not take alcohol, supported by the fact that older population in Malaysia had low alcohol intake (5). For physical activity status, most of the subjects were reported as “not active”. However, performing physical activity and exercise can be a way to prevent fracture among older population (6).
For the analyses of three months’ follow-up, 89 patients were still available, and the results showed that most of the patients took calcium and vitamin D as supplements. However, the in-take of anti-osteoporotic drugs by patients were low and it was in line with several previous studies (7, 8). A meta-analysis study has recommended the use of calcium in combination with vitamin D supplementation as a preventive treatment for fractures and bone loss in older adult (9). Older adults should be alert to the associated factors of osteoporotic fractures. Majority of the patients were taking calcium for preventive measure, but the use of osteoporotic drugs was very low.
Footnotes
Conflict of Interest
The authors declare that there is no conflict of interest.
References
- 1.Keng Yin L, King Hock S, et al. (2008). Risk factors for fragility fracture in Seremban district, Malaysia: a comparison of patients with fragility fracture in the orthopedic ward versus those in the outpatient department. Asia Pac J Public Health, 20 (3): 251–7. [DOI] [PubMed] [Google Scholar]
- 2.Endo Y, Aharonoff GB, Zuckerman JD, et al. (2005). Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma, 19 (1): 29–35. [DOI] [PubMed] [Google Scholar]
- 3.Norimah A, Safiah M, Jamal K, et al. (2008). Food Consumption Patterns: Findings from the Malaysian Adult Nutrition Survey (MANS). Malays J Nutr, 14(1):25–39. [PubMed] [Google Scholar]
- 4.Lim KH, Jasvindar K, Cheong SM, et al. (2016). Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study. Tob Induc Dis, 14: 8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Mutalip MHBA, Kamarudin RB, Manickam M, et al. (2014). Alcohol Consumption and Risky Drinking Patterns in Malaysia: Findings from NHMS 2011. Alcohol Alcohol, 49 (5): 593–9. [DOI] [PubMed] [Google Scholar]
- 6.Ahmad Mohd Sharkawi, Mohamed Isa Naina, Mokhtar Sabarul Afian, et al. (2015). Review of the Risk Factor of Osteoporosis in the Malaysian Population. Research Updates in Medical Sciences (RUMeS), 3 (1): 77–82. [Google Scholar]
- 7.Rabenda V, Vanoverloop J, Fabri V, et al. (2008). Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am, 90(10):2142–8. [DOI] [PubMed] [Google Scholar]
- 8.Giangregorio L, Papaioannou A, Cranney A, et al. (2006). Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum, 35 (5): 293–305. [DOI] [PubMed] [Google Scholar]
- 9.Tang BM, Eslick GD, Nowson C, et al. (2007). Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet, 370 (9588): 657–66. [DOI] [PubMed] [Google Scholar]