Dysmobility syndrome: a paradigm shift in fracture prevention
Keywords:fracture, osteoporosis, sarcopenia, dysmobility syndrome, falls
Fragility fractures engender major healthcare cost, reduce independence/quality and life and increase mortality risk. Despite availability of multiple therapies to reduce risk for future fracture, few patients are treated even following hip fracture. Clearly, approaches of the past aimed at reducing fragility fracture risk, primarily by diagnosing osteoporosis and initiating bone-active medications, have failed. A different approach is required; such a change in focus is proposed here. Briefly, the dysmobility syndrome concept recognizes fragility fracture as the clinical outcome of consequence and appreciates that osteoporosis is only part of the syndrome leading to “osteoporosis-related” fracture. Other components of this syndrome include sarcopenia, obesity, diabetes, osteoarthritis, and potentially multiple other factors that increase risk for falls with attendant increased fracture risk. In summary, the dysmobility syndrome concept moves the field, and also, importantly, older adults at risk for fragility fracture, beyond a singular focus on bone to more appropriately focus on a holistic approach to fracture risk reduction.
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis Medication Use after Hip Fracture in U.S. Patients between 2002 and 2011. J Bone Miner Res. 2014;29(9):1929-37. doi: 10.1002/jbmr.2202.
Kim SC, Kim DH, Mogun H. Impact of the U.S. Food and Drug Administration's Safety-Related Announcements on the Use of Bisphosphonates After Hip Fracture. J Bone Miner Res. 2016;31(8):1536-40. doi: 10.1002/jbmr.2832.
Akesson K, Marsh D, Mitchell PJ, et al. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24(8):2135-52. doi: 10.1007/s00198-013-2348-z.
Eisman JA, Bogoch ER, Dell R, Harrington JT, et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res. 2012;27(10):2039-46. doi: 10.1002/jbmr.1698.
Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int. 2014;25(5):1439-43. doi: 10.1007/s00198-014-2655-z.
Siris ES, Boonen S, Mitchell PJ, Bilezikian J, Silverman S. What's in a name? What constitutes the clinical diagnosis of osteoporosis? Osteoporos Int, 2012;23(8):2093-7. doi: 10.1007/s00198-012-1991-0.
Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348(9041):1535-41. PMID: 8950879.
Neer RM1, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-41. doi: 10.1056/NEJM200105103441904.
Parkkari J, Kannus P, Palvanen M, et al. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. 1999;65(3):183-7. PMID: 10441647.
Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249-56. doi: 10.1016/j.jamda.2011.01.003.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23. doi: 10.1093/ageing/afq034.
Studenski SA, Peters KW, Alley DE, et al. The FNIH Sarcopenia Project: Rationale, Study Description, Conference Recommendations, and Final Estimates. J Gerontol A Biol Sci Med Sci. 2014;69(5):547-58. doi: 10.1093/gerona/glu010.
Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332(12):767-73. doi: 10.1056/NEJM199503233321202.
Roy DK, O'Neill TW, Finn JD, et al. Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int. 2003;14(1):19-26. doi: 10.1007/s00198-002-1317-8.
Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int. 2008;19(10):1431-44. doi: 10.1007/s00198-008-0588-0.
Binkley N, Krueger D, Buehring B. What's in a name revisited: should osteoporosis and sarcopenia be considered components of "dysmobility syndrome?". Osteoporos Int. 2013;24(12):2955-9. doi: 10.1007/s00198-013-2427-1.
Wang J, You W, Jing Z, Wang R, Fu Z, Wang Y. Increased risk of vertebral fracture in patients with diabetes: a meta-analysis of cohort studies. Int Orthop. 2016;40(6):1299-307. doi: 10.1007/s00264-016-3146-y.
Prieto-Alhambra D, Nogues X, Javaid MJ, et al. An increased rate of falling leads to a rise in fracture risk in postmenopausal women with self-reported osteoarthritis: a prospective multinational cohort study (GLOW). Ann Rheum Dis. 2013;72(6):911-7. doi: 10.1136/annrheumdis-2012-201451.
Zasadzka E, Borowicz AM, Roszak M, Pawlaczyk M. Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis. Clin Interv Aging. 2015;10:1289-98. doi: 10.2147/CIA.S86001.
Rolita L, Spegman A, Tang X, Cronstein BN. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults. J Am Geriatr Soc. 2013;61(3):335-40. doi: 10.1111/jgs.12148.
Clynes MA, Edwards MH, Buehring B, Dennison EM, Binkley N, Cooper C.Definitions of Sarcopenia: Associations with Previous Falls and Fracture in a Population Sample. Calcif Tissue Int. 2015;97(5):445-52. doi: 10.1007/s00223-015-0044-z.
Buehring B, Lewis B, Hansen K, et al. Association of Musculoskeletal Health Score with Fracture Risk in the MrOS cohort. J Bone Miner Res. 2016;31(Suppl 1). Available from: http://www.asbmr.org/education/AbstractDetail?aid=104ce55b-45f8-4bcb-9b01-402428abafe4.
Osler W. Sir William Osler. Aphorisms, ed. W.B. Bean. 1961, Springfield IL: C. C. Thomas, Oxford, Blackwell Scientific Publs.
How to Cite
Copyright (c) 2017 Neil Binkley, Diane Krueger
This work is licensed under a Creative Commons Attribution 4.0 International License.