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Skeletal Aging and Osteoporosis pp 133–150Cite as

Factor of Risk for Fracture

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Part of the book series: Studies in Mechanobiology, Tissue Engineering and Biomaterials ((SMTEB,volume 5))

Abstract

In considering the risk of fracture, both the loading applied to a bone and strength of the bone are of importance. A conceptually simple approach for considering both loading and strength is the factor of risk, Φ, which is the ratio of applied load to failure load for a particular loading scenario. Theoretically a fracture will occur if Φ ≥ 1. The factor of risk may provide a better measure for risk of fracture than current clinical measures such as bone mineral density. However, the challenges of accurately determining both applied load and failure load are significant. A number of studies have examined factor of risk for hip, vertebral and distal forearm fractures. At all three locations, factor of risk has been found to increase with age, and to be associated with incident or prevalent fractures. While some studies show promising results, the factor of risk has not been consistently better than bone mineral density alone in predicting the risk of fracture. However, it should be noted that the approaches used to estimate applied load and failure load in most studies have been relatively simple. Furthermore, only a few loading conditions have been investigated, primarily fall impact to the side for the hip, forward flexion/lifting for the vertebral body and forward fall onto the hand for the distal forearm. Thus, in spite of its limitations and challenges, factor of risk may still provide significant insight into the etiology of osteoporotic fractures, especially as methods for determining bone loading and strength improve.

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Notes

  1. 1.

    odds ratio (OR) is defined as the odds of an event occurring in one group, divided by the odds of the it occurring in another group.

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Acknowledgments

We would like to acknowledge funding from the National Institutes of Health: R01AR053986 and a postdoctoral fellowship from the Harvard Translational Research in Aging Training Program (T32AG023480).

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  1. Department of Orthopedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Dennis E. Anderson & Mary L. Bouxsein

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Correspondence to Mary L. Bouxsein .

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  1. Dept. Orthopaedic Surgery, Washington University, St. Louis, Barnes-Jewish Hospital Plaza 1, St. Louis, 63110, Missouri, USA

    Matthew J. Silva

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Anderson, D.E., Bouxsein, M.L. (2013). Factor of Risk for Fracture. In: Silva, M. (eds) Skeletal Aging and Osteoporosis. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8415_2011_110

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