Reduced Bone Mineral Density as an Independent Predictor of Fragility Fractures in Older Adults: A Case–Control Analysis
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Abstract
Background: Fragility fractures represent a significant public health concern among older adults and are associated with substantial morbidity, mortality, reduced quality of life, and increased healthcare costs. Osteoporosis, characterized by decreased bone mineral density (BMD) and deterioration of bone microarchitecture, is a major underlying risk factor for these fractures. Early identification of individuals at high risk through BMD assessment may facilitate timely preventive interventions and reduce fracture burden.
Objectives: To evaluate the association between bone mineral density and fragility fractures in elderly patients and to estimate fracture risk across different World Health Organization (WHO) BMD diagnostic categories.
Methods: This case–control study included elderly patients aged 60 years and above with clinically confirmed fragility fractures (cases) and age- and sex-matched controls without a history of fracture. All participants underwent dual-energy X-ray absorptiometry (DXA) scanning for assessment of BMD at the femoral neck and lumbar spine. T-scores were categorized according to WHO criteria as normal, osteopenia, or osteoporosis. Differences in BMD parameters between groups were analyzed using appropriate statistical tests. Multivariable logistic regression analysis was performed to identify independent predictors of fragility fractures and calculate adjusted odds ratios (aORs).
Results: Patients with fragility fractures exhibited significantly lower mean femoral neck T-scores compared with controls (approximately −2.7 vs. −1.4; p < 0.001). Osteoporosis was considerably more prevalent among cases and was independently associated with an increased risk of fragility fracture (aOR ≈ 3.6). Advanced age and a previous history of fracture also emerged as significant independent risk factors. Fracture risk increased progressively across worsening BMD categories.
Conclusion: Reduced bone mineral density was strongly and independently associated with fragility fractures in elderly patients. These findings support routine DXA-based screening, early identification of osteoporosis, and timely initiation of preventive and therapeutic strategies to reduce fracture risk and improve skeletal health in older adults.
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References
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