Background Osteoporosis is defined as a systemic skeletal disease characterized by low mineral density and microarchitectural changes in the bone which increase its fragility and fracture risk. Ankle fracture is one of the most common fractures; however the relation with osteoporosis is still being debated. The diagnosis and treatment of osteoporosis is not always adequate.
Objectives To determine the relation of ankle fractures to osteoporosis
Methods Retrospective study 2008–2014. Center: Tertiary academic hospital with a referral area of 850,000 inhabitants. The medical charts, bone mineral density (BMD), radiographs and electronic data bases of patients with ankle fracture were reviewed. Demographic data (age, gender), BMD, mechanism of injury (high or low energy trauma), fracture pattern (single malleolus, bimaleollar and trimalleolar fracture) and treatment of fracture and osteoporosis were collected. Patients were divided into younger age (≤60years) and older age (>60 years) groups.
Results A total of 299 patients with ankle fractures were included. The mean age was 49.5 years (DS 26.5). There were 131 (43.8%) male and 168 (56.2%) female patients. Among these patients, 84 (28.1%) were in the older age group (74% female and 26% male) and 216 (72.2%) were in the younger age group (51% male and 49% female). Bimaleolar fracture was the most common pattern in both groups (62.7% and 50.5%). Proportion of low energy trauma and conservative treatment was higher in elderly group compared to younger group (63.9% vs 38%, p 0.002/20.5% vs 8.3%; p 0.003). Of note 34 (11.7%) of patients underwent a dual-energy X-ray absorptiometry (DXA): 17 (50%) in the elderly group and 17 (50%) in younger (82% were older than 50 years). In the older group only 1 (5.9%) patient had a normal BMD, 8 (47.1%) had osteopenia and 8 (47.1%) had osteoporosis. Compared with younger patients, osteoporosis was more frequent in older group (10.8% vs 1.4%; p<0.005). Older patients had a higher proportion of new fractures than younger (23.8% vs 12.6%; p 0.016), between 3 and 60 months after the ankle fracture. The new fractures were: 9 Colles', 4 vertebral, 4 hip and 3 in other location.
Conclusions Ankle fracture was more common in females in the older group. DXA was performed in a very low percentage of cases. The features of ankle fractures and the higher ratio of new fractures in the older group suggest a possible link with osteoporosis. Patients with ankle fracture should be studied in order to diagnose osteoporosis. These patients may have a benefit of treatment.
Disclosure of Interest None declared