RESULTS OF THE ANALYSIS OF RISK FACTORS AND ABSOLUTE RISK OF FRACTURE (FRAX) IN MEN WITH FRACTURES OF THE PROXIMAL FEMUR

Abstract

Fractures of the proximal femur (FPF) significantly affect the increase of mortality and disability in men. According to the data of the epidemiological studies in Russian Federation the incidence FPF at the age of 65 years is higher in men than in women, which is different from those obtained in most other countries. Objective: To assess the risk factors for fracture and to estimate the risk of fracture using the FRAX in order to calculate the absolute risk of fracture in men with occurred FPF. Materials and Methods: We performed a cross-sectional continuous epidemiological study. The study group included 128 men 40-69 years old with FPF, the comparison group consisted of 108 patients with FPF 70 years of age or older. The patients filled out questionnaires to assess the risk factors for fracture. Alcohol consumption was estimated based on the results of tests «CAGE» and «Audit». In order to identify vertebral fractures we performed radiography of thoracic and lumbar spine with morphometric studies. We measured the levels of testosterone and 17-estradiol electrochemiluminescence immunoassay «ECLIA» (Elecsys 2010). FRAX (www.shef.ac.uk\FRAX) was applied to estimate the absolute risk of fracture; the results were interpreted according to the schedule thresholds depending on the patient’s age (www.osteoporoz.ru). Statistical analysis was performed using STATISTICA v.10.0 software. Results: The patients in the study group had more prior fractures (p<0,05), more of them were smokers (p <0,002), systematically drank alcohol (p <0,05). Secondary osteoporosis was detected in 53 (41.40%) of men in this study group, including hypogonadism in 49 (41.88%) patients. Only 6 (4.69%) patients had no risk factors, a single risk factor noted in 20 (15.63%), two in 47 (36.72%), three or more in 55 (42.97%) patients. High risk of fractures by FRAX was observed in 17 (16.66%) in the treatment group and in 2 (1.85%) of men in the comparison group. Conclusion: The high incidence of FPF in men up to 69 years of age in Russia can be explained by their having a large number of major risk factors for osteoporotic fractures, especially of previous fractures, smoking, systematic use / abuse of alcohol and hypogonadism. A small number of individuals with FRAX values above the threshold level indicate the need for further epidemiological studies with a large number of observations that would lead to increase in the sensitivity of FRAX and would specify the threshold values of this index.