Age impact on clinical risk factors does not justify the age related change in referral pattern for osteoporosis assessment-Data from the Aalborg University Hospital Record for Osteoporosis Risk Assessment (AURORA)

BACKGROUND: Osteoporotic fractures with subsequent disability, dependency and premature death are increasingly common with age. Yet, referral for osteoporosis evaluation decreases with age. Why is this, and is it justified?

PURPOSE: To assess if age changes the impact of clinical risk factors for osteoporosis.

METHODS: Clinical risk factors for osteoporosis were informed by a questionnaire and recorded in the AURORA database along with anthropometry and bone mineral density measured by dual energy X-ray absorptiometry (DXA). We included data from the first DXA in all individuals seen at the Osteoporosis Clinic in North Denmark in 2010 through 2012.

RESULTS: Risk factor data were available in >96% and DXA in >98% of the 8131 evaluations. Age 80+ years was the dominant risk factor for fragility fracture (P<0.001) and for osteoporosis by DXA (P<0.001). The occurrence of clinical risk factors differed by age <80 or 80+ years: P<0.001 for family history, present smoker, excess alcohol intake, secondary disease, low sun exposure, fragility fracture; P=0.002 for early menopause; P=0.015 for corticosteroid; P=0.046 for low dairy product consumption. Age increased the impact of female gender (interaction term in logistic regression: P=0.004 for fragility fracture; P=0.040 for BMD). Age had no influence on the importance of any other clinical risk factor for the occurrence of fragility fracture.

CONCLUSION: High age carried the highest risk for fragility fracture and for osteoporosis by DXA. Clinical risk factors changed with age in those referred for evaluation. This change was not justified by the impact of clinical risk factors.