{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:16:11Z","timestamp":1760242571630,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2017,11,13]],"date-time":"2017-11-13T00:00:00Z","timestamp":1510531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG8F1791"],"award-info":[{"award-number":["CMRPG8F1791"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Osteoporotic fractures are defined as low-impact fractures resulting from low-level trauma. However, the exclusion of high-level trauma fractures may result in underestimation of the contribution of osteoporosis to fractures. In this study, we aimed to investigate the fracture patterns of female trauma patients with various risks of osteoporosis based on the Osteoporosis Self-Assessment Tool for Asians (OSTA) score. Methods: According to the data retrieved from the Trauma Registry System of a Level I trauma center between 1 January 2009 and 31 December 2015, a total of 6707 patients aged \u226540 years and hospitalized for the treatment of traumatic bone fracture were categorized as high-risk (OSTA &lt; \u22124, n = 1585), medium-risk (\u22121 \u2265 OSTA \u2265 \u22124, n = 1985), and low-risk (OSTA &gt; \u22121, n = 3137) patients. Two-sided Pearson\u2019s, chi-squared, or Fisher\u2019s exact tests were used to compare categorical data. Unpaired Student\u2019s t-test and Mann\u2013Whitney U-test were used to analyze normally and non-normally distributed continuous data, respectively. Propensity-score matching in a 1:1 ratio was performed with injury mechanisms as adjusted variables to evaluate the effects of OSTA-related grouping on the fracture patterns. Results: High- and medium-risk patients were significantly older, had higher incidences of comorbidity, and were more frequently injured from a fall and bicycle accident than low-risk patients did. Compared to low-risk patients, high- and medium-risk patients had a higher injury severity and mortality. In the propensity-score matched population, the incidence of fractures was only different in the extremity regions between high- and low-risk patients as well as between medium- and low-risk patients. The incidences of femoral fractures were significantly higher in high-risk (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.73\u20134.24; p &lt; 0.001) and medium-risk patients (OR, 1.4; 95% CI, 1.24\u20131.54; p &lt; 0.001) than in low-risk patients. In addition, high-risk patients had significantly lower odds of humeral, radial, patellar, and tibial fractures; however, such lower odds were not found in medium- risk than low-risk patients. Conclusions: The fracture patterns of female trauma patients with high- and medium-risk osteoporosis were different from that of low-risk patients exclusively in the extremity region.<\/jats:p>","DOI":"10.3390\/ijerph14111380","type":"journal-article","created":{"date-parts":[[2017,11,13]],"date-time":"2017-11-13T11:12:36Z","timestamp":1510571556000},"page":"1380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiology of Bone Fracture in Female Trauma Patients Based on Risks of Osteoporosis Assessed using the Osteoporosis Self-Assessment Tool for Asians Score"],"prefix":"10.3390","volume":"14","author":[{"given":"Cheng-Shyuan","family":"Rau","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0984-6921","authenticated-orcid":false,"given":"Shao-Chun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pao-Jen","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Chun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng-Chen","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiao-Yun","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0945-2746","authenticated-orcid":false,"given":"Ching-Hua","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.bone.2015.04.016","article-title":"Osteoporosis and sarcopenia in older age","volume":"80","author":"Edwards","year":"2015","journal-title":"Bone"},{"unstructured":"National Clinical Guideline (2012). National Institute for Health and Clinical Excellence: Guidance, Osteoporosis: Fragility Fracture Risk: Osteoporosis: Assessing the Risk of Fragility Fracture.","key":"ref_2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s001980170112","article-title":"The burden of osteoporotic fractures: A method for setting intervention thresholds","volume":"12","author":"Kanis","year":"2001","journal-title":"Osteoporos. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"Marshall","year":"1996","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1007\/s00198-004-1702-6","article-title":"Epidemiology of osteoporotic fractures","volume":"16","author":"Johnell","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.11005\/jbm.2015.22.4.175","article-title":"Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research","volume":"22","author":"Yoo","year":"2015","journal-title":"J. Bone Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1359\/jbmr.1998.13.8.1337","article-title":"The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: The Geelong Osteoporosis Study","volume":"13","author":"Sanders","year":"1998","journal-title":"J. Bone Miner. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1007\/s001980170075","article-title":"Determinants of bone mineral density and spinal fracture risk in postmenopausal Japanese women","volume":"12","author":"Nakaoka","year":"2001","journal-title":"Osteoporos. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/s00223-017-0244-9","article-title":"Location of Vertebral Fractures is Associated with Bone Mineral Density and History of Traumatic Injury","volume":"100","author":"Watt","year":"2017","journal-title":"Calcif. Tissue Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s11657-016-0278-z","article-title":"A systematic review of intervention thresholds based on FRAX: A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation","volume":"11","author":"Kanis","year":"2016","journal-title":"Arch. Osteoporos."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1038\/bonekey.2016.82","article-title":"Role of cortical bone in hip fracture","volume":"6","author":"Reeve","year":"2017","journal-title":"Bonekey Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ejogrb.2016.05.011","article-title":"Increased risk of humerus and lower leg fractures in postmenopausal women with self-reported premenopausal hirsutism and\/or oligomenorrhea","volume":"203","author":"Comim","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1007\/s00264-014-2362-6","article-title":"Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures","volume":"38","author":"Bahrs","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.bone.2014.10.026","article-title":"Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study\u2013comparing site and age-specific risks in women and men","volume":"71","author":"Prior","year":"2015","journal-title":"Bone"},{"key":"ref_15","first-page":"1629","article-title":"Divergent effects of obesity on fragility fractures","volume":"9","author":"Caffarelli","year":"2014","journal-title":"Clin. Interv. Aging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.ecl.2015.05.002","article-title":"Bone Health and Osteoporosis","volume":"44","author":"Lupsa","year":"2015","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s001980170070","article-title":"A simple tool to identify asian women at increased risk of osteoporosis","volume":"12","author":"Koh","year":"2001","journal-title":"Osteoporos. Int."},{"doi-asserted-by":"crossref","unstructured":"Yang, Y., Wang, B., Fei, Q., Meng, Q., Li, D., Tang, H., Li, J., and Su, N. (2013). Validation of an osteoporosis self-assessment tool to identify primary osteoporosis and new osteoporotic vertebral fractures in postmenopausal Chinese women in Beijing. BMC Musculoskelet. Disord., 14.","key":"ref_18","DOI":"10.1186\/1471-2474-14-271"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s00198-009-1036-5","article-title":"Selecting men for bone densitometry: Performance of osteoporosis risk assessment tools in Portuguese men","volume":"21","author":"Machado","year":"2010","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.jocd.2015.01.001","article-title":"Performance of the Osteoporosis Self-Assessment Tool for Asians (OSTA) in Screening Osteoporosis Among Middle-Aged and Old Women in the Chengdu Region of China","volume":"18","author":"Huang","year":"2015","journal-title":"J Clin. Densitom."},{"doi-asserted-by":"crossref","unstructured":"Chen, C.C., Rau, C.S., Wu, S.C., Kuo, P.J., Chen, Y.C., Hsieh, H.Y., and Hsieh, C.H. (2016). Association of Osteoporosis Self-Assessment Tool for Asians (OSTA) Score with Clinical Presentation and Expenditure in Hospitalized Trauma Patients with Femoral Fractures. Int. J. Environ. Res. Public Health, 13.","key":"ref_21","DOI":"10.3390\/ijerph13100995"},{"doi-asserted-by":"crossref","unstructured":"Rau, C.S., Kuo, P.J., Wu, S.C., Chen, Y.C., Hsieh, H.Y., and Hsieh, C.H. (2016). Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis. Int. J. Environ. Res. Public Health, 13.","key":"ref_22","DOI":"10.3390\/ijerph13121203"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"35","DOI":"10.5704\/MOJ.1203.011","article-title":"Performance of Osteoporosis Self-assessment Tool for Asian (OSTA) for Primary Osteoporosis in Post-menopausal Malay Women","volume":"6","author":"Muslim","year":"2012","journal-title":"Malays. Orthop. J."},{"key":"ref_24","first-page":"130","article-title":"Correlation of osteoporosis screening by quantitative ultrasound of calcaneus and Osteoporosis Self-Assessment Tool for Asians in Taiwanese","volume":"103","author":"Yang","year":"2004","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1385\/JCD:6:3:247","article-title":"Korean experience with the OSTA risk index for osteoporosis: A validation study","volume":"6","author":"Park","year":"2003","journal-title":"J. Clin. Densitom."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1007\/s00198-005-0051-4","article-title":"Validation of various osteoporosis risk indices in elderly Chinese females in Singapore","volume":"17","author":"Chan","year":"2006","journal-title":"Osteoporos. Int."},{"key":"ref_27","first-page":"1286","article-title":"Validation of the OSTA index for discriminating between high and low probability of femoral neck and lumbar spine osteoporosis among Thai postmenopausal women","volume":"87","author":"Geater","year":"2004","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1007\/s00198-005-1929-x","article-title":"Validation of OSTA among Filipinos","volume":"16","author":"Llamado","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.jocd.2016.04.005","article-title":"Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Predicting Osteoporosis in Indian Men","volume":"20","author":"Bhat","year":"2017","journal-title":"J. Clin. Densitom."},{"key":"ref_30","first-page":"420","article-title":"Comparison of osteoporosis self assessment tool for Asian (OSTA) and standard assessment in Menopause Clinic, Chiang Mai","volume":"90","author":"Chaovisitsaree","year":"2007","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1749-799X-1-14","article-title":"Concordane of OSTA and lumbar spine BMD by DXA in identifying risk of osteoporosis","volume":"1","author":"Lu","year":"2006","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.bj.2016.10.005","article-title":"Differences between the sexes in motorcycle-related injuries and fatalities at a Taiwanese level I trauma center","volume":"40","author":"Hsieh","year":"2017","journal-title":"Biomed. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.bj.2016.10.006","article-title":"Motorcycle-related hospitalizations of the elderly","volume":"40","author":"Hsieh","year":"2017","journal-title":"Biomed. J."},{"unstructured":"World Health Organization (1995). Physical Status: The Use and Interpretation of Anthropometry, World Health Organization. Report of a WHO Expert Committee.","key":"ref_34"},{"unstructured":"World Health Organization (2000). Obesity: Preventing and Managing the Global Epidemic, World Health Organization. Report of a WHO consultation.","key":"ref_35"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness. A practical scale","volume":"2","author":"Teasdale","year":"1974","journal-title":"Lancet"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3109\/02699052.2012.743182","article-title":"Meta-analysis of Glasgow coma scale and simplified motor score in predicting traumatic brain injury outcomes","volume":"27","author":"Singh","year":"2013","journal-title":"Brain Inj."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1001\/jamasurg.2014.13","article-title":"The effect of age on Glasgow Coma Scale score in patients with traumatic brain injury","volume":"149","author":"Salottolo","year":"2014","journal-title":"JAMA Surg."},{"key":"ref_39","first-page":"13","article-title":"Adding up the Glasgow Coma Score","volume":"28","author":"Teasdale","year":"1979","journal-title":"Acta Neurochir. Suppl."},{"doi-asserted-by":"crossref","unstructured":"(1971). Rating the severity of tissue damage. I. The abbreviated scale. JAMA, 215, 277\u2013280.","key":"ref_40","DOI":"10.1001\/jama.215.2.277"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J. Trauma"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/S0736-0266(00)00046-2","article-title":"Effect of force direction on femoral fracture load for two types of loading conditions","volume":"19","author":"Keyak","year":"2001","journal-title":"J. Orthop. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1007\/s00198-004-1746-7","article-title":"Treatment strategies for proximal femur fractures in osteoporotic patients","volume":"16","author":"Bonnaire","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s00198-010-1305-3","article-title":"Obesity alters cortical and trabecular bone density and geometry in women","volume":"22","author":"Sukumar","year":"2011","journal-title":"Osteoporos. Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/BOT.0000000000000546","article-title":"Obesity Increases Complexity of Distal Radius Fracture in Fall From Standing Height","volume":"30","author":"Ebinger","year":"2016","journal-title":"J. Orthop. Trauma"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.amjmed.2011.06.013","article-title":"Obesity is not protective against fracture in postmenopausal women: GLOW","volume":"124","author":"Compston","year":"2011","journal-title":"Am. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1001\/jama.2016.19087","article-title":"Osteoporosis and Fracture Risk Evaluation and Management: Shared Decision Making in Clinical Practice","volume":"317","author":"Watts","year":"2017","journal-title":"JAMA"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/BOT.0b013e3182a5a045","article-title":"Orthogeriatric care models and outcomes in hip fracture patients: A systematic review and meta-analysis","volume":"28","author":"Grigoryan","year":"2014","journal-title":"J. Orthop. Trauma"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s00198-015-3443-0","article-title":"Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate","volume":"27","author":"Nakayama","year":"2016","journal-title":"Osteoporos. Int."},{"doi-asserted-by":"crossref","unstructured":"Pape, H.C., and Bischoff-Ferrari, H.A. (2017). How can we influence the incidence of secondary fragility fractures? A review on current approaches. Injury.","key":"ref_50","DOI":"10.1016\/j.injury.2017.08.034"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1056\/NEJM199503233321202","article-title":"Risk factors for hip fracture in white women","volume":"332","author":"Cummings","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s11657-012-0095-y","article-title":"Declining incidence of osteoporotic hip fracture in Australia","volume":"7","author":"Crisp","year":"2012","journal-title":"Arch. Osteoporos."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s13018-017-0539-6","article-title":"Evaluation of Singh Index and Osteoporosis Self-Assessment Tool for Asians as risk assessment tools of hip fracture in patients with type 2 diabetes mellitus","volume":"12","author":"Liu","year":"2017","journal-title":"J. Orthop. Surg. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1380\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:49:18Z","timestamp":1760208558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,13]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11]]}},"alternative-id":["ijerph14111380"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14111380","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2017,11,13]]}}}