Endocrine Abstracts

Objective: To identify the prevalent fracture risk factors in the group of persons 50 years and older. Assess their impact on BMD in patients with a distal forearm fracture (DFF-fracture of the radius) over 50 years at low injury.

Materials and methods: A comparative study among patients with DFF in the age group 50 years and older. Study based on medical records of city hospital traum depatment. Analised period 2009–2012. All patients underwent R-densitometry on the unit DTX-200, provided by Nicomed Takeda in the framework of the program ‘Russian Osteoscreening’.

Results: Hospital records of patients 50 years and older who suffered from low-energy fracture of the distal forearm were analyzed retrospectively for the period of 2009–2012. 791 patients were interviewed using standardized questionnaires ‘Osteoscreening Russia’. According to the survey the metabolic syndrome (MS) diagnosed in 70.8% (560 persons). It included type 2 diabetes mellitus (T2DM) −14.8% (117 persons), prediabetes −22.9% (181 people) – (Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)), obesity (33.1%) – an isolated cohort of patients with overweight and obesity without disrupting glycemic indices. All patients had DFF that occurred at a low injury. Among the investigated cohort of patients with highnormal bone mineral density (BMD above −1.0 standard deviation (S.D.))we revealed 66.0% of patients with MS; 64.1% – with obesity; 65.4% – with the presence of pre-diabetes; 65.3% – with a history of type 2 diabetes. BMD−1.0–2.5 S.D.: 20.6% with MS; obesity, 20.2%; prediabetes, 19.7%; type 2 diabetes −19.5% BMD below 2.5 standard deviations (S.D.): MS at 13.5%; obesity, 15.7%; prediabetes, 14.7%; Type 2 DM −15.3%. Patients with low-energy DFF with a history of metabolic syndrome differed from the group of patients without this disease by its high and highnormal % normal BMD. Almost 2/3 (70.8%) of patients with metabolic syndrome have normal BMD.

Conclusion: The prevalence of low BMD in patients of investigated groups has not been established. Proposed mechanism of fracture is focused not on the performance of T-score (BMD) but the bone quality due to changes caused by abnormality of bone metabolism. Suppression of medullary osteoblastogenesis by adipocytes of bone marrow and stimulation of proinflammatory cytokines synthesis leads to increased bone fragility without decreasing BMD.