Lower Fracture Incidence in a Population of Nonagenarians

People who survive to exceptional old age tend to do so because they have a lower burden of damage and dysfunction. A lesser degree of chronic inflammation maintained over time, for example, improves the long-term function of organs throughout the body. That in turn leads to a lesser degree of age-related disease and the lower mortality rate needed in order to survive to exceptional old age. Thanks to variations in lifestyle and burden of persistent infection, one can find groups with better health than average, such as the nonagenarians noted here, who collectively exhibit a significantly lower risk of fracture due to weakened bone strength. As to why they are better off, that question is left unanswered by the authors of this paper. It is interesting to note the metrics that were not different, such weight and common blood markers associated with bone health.

The goal of this study was to investigate whether various aspects of bone health among the very elderly could provide insight into the aging process in this unique population. Our study investigated the prominence of fractures, osteopenia, and osteoporosis among our study population and made comparative analyses specifically looking at metabolic values and blood indices characteristic of bone health as well as the impact of prescribed medication therapies.

Overall, we found a low rate of fractures in our group of patients over 90 years of age. The distribution of fractures found in our study correlates with the expected distribution of fractures for an elderly cohort, with the most common occurring at the spine and hip. Additionally, there was a trend toward lower incidence of fracture among the oldest individuals, as compared to the general very old population in the United States. The incidence for hip fractures in the ≥100-year-old population has been estimated to be 23.1 per 1000 individuals per year (2.3% per year), whereas our study found a fracture incidence of 1.9% per year among our population of very elderly individuals. This indicates that our population of nonagenarians may have characteristics that contributed to the preservation of bone health even into extreme old age.

In conclusion, patients over 90 years of age had an overall low prevalence of fractures and relative preservation of bone health, suggesting a preserved bone molecular profile in these individuals. Epigenetic factors and activity levels might also have favorably affected bone health. The low percentage of osteoporosis and fractures likely reduced the morbidity and mortality in this population, potentially contributing to their overall longevity.

Link: https://doi.org/10.1177%2F21514593211036231

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